Individual
MIRIAM LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2169 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7059
(530) 543-5400
Mailing address
2169 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7059
(530) 543-5400
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A162641
CA
Other
Enumeration date
03/28/2014
Last updated
05/11/2023
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