Individual
MIRELLA SQUILLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4940 VAN NUYS BLVD, SHERMAN OAKS, CA 91403-1700
(818) 907-0952
Mailing address
10620 BALBOA BLVD APT 117, GRANADA HILLS, CA 91344-6333
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
48873
CA
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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