Individual
MIKI STACY OHATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3900 W COAST HWY STE 310, NEWPORT BEACH, CA 92663-4093
(949) 478-8858
Mailing address
1228 PHILLIPS CT, SANTA CLARA, CA 95051-3816
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95012564
CA
363LG0600X
Gerontology Nurse Practitioner
95012564
CA
Other
Enumeration date
09/25/2019
Last updated
11/26/2019
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