Individual
MIA NEPOMUCENO-PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11370 ANDERSON ST, STE 2960, LOMA LINDA, CA 92354-3450
(909) 558-6422
Mailing address
PO BOX 1740, LOMA LINDA, CA 92354-0240
(909) 558-6422
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
A65593
CA
207ZP0101X
Anatomic Pathology Physician
Primary
A65593
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A655930
—
CA
Enumeration date
07/20/2006
Last updated
02/01/2012
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