Individual
MIRACLE KENNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
711 W 54TH ST, LOS ANGELES, CA 90037-3723
(323) 593-1035
Mailing address
711 W 54TH ST, LOS ANGELES, CA 90037
(323) 593-1035
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
D8116361
CA
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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