Provider Demographics
NPI:1881666774
Name:PURNELL, MIKI T (MD)
Entity type:Individual
Prefix:DR
First Name:MIKI
Middle Name:T
Last Name:PURNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIKI
Other - Middle Name:
Other - Last Name:TANAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 S MANCHESTER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3219
Mailing Address - Country:US
Mailing Address - Phone:714-456-2986
Mailing Address - Fax:
Practice Address - Street 1:856 HEALTH SCIENCES RD STE 260
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-3058
Practice Address - Country:US
Practice Address - Phone:499-824-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80786207Q00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine