Provider Demographics
NPI:1962199893
Name:DE SILVA, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9345 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2901
Mailing Address - Country:US
Mailing Address - Phone:213-804-7417
Mailing Address - Fax:
Practice Address - Street 1:9345 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2901
Practice Address - Country:US
Practice Address - Phone:213-804-7417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4384148374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula