Individual
MIKIA AIVAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19331 PINE VALLEY AVE, PORTER RANCH, CA 91326-1403
(818) 934-3463
Mailing address
19331 PINE VALLEY AVE, PORTER RANCH, CA 91326-1403
(818) 934-3463
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
00000000
CA
Other
Enumeration date
11/05/2024
Last updated
11/05/2024
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