Individual
MIIKELLA DANIELLE HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
255 E BONITA AVE, POMONA, CA 91767-1923
(909) 596-7733
Mailing address
17123 CRABAPPLE LN, FONTANA, CA 92337-6871
(909) 782-7153
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
07/02/2018
Last updated
08/09/2021
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