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Individual
MICKOYAN NAKITA POOLE
Active
Individual
MICKOYAN NAKITA POOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15766
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316201734
—
CA
Enumeration date
06/29/2012
Last updated
02/07/2022
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