Provider Demographics
NPI:1932786647
Name:MYERS, MICHAEL (NA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 LE BORGNE AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2308
Mailing Address - Country:US
Mailing Address - Phone:970-773-8734
Mailing Address - Fax:
Practice Address - Street 1:363 LE BORGNE AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-2308
Practice Address - Country:US
Practice Address - Phone:970-773-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide