Individual
THOMAS ALAN MIKLUSAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
180 S LAKE AVE, SUITE 255, PASADENA, CA 91101
(626) 792-9949
(818) 952-5360
Mailing address
180 S LAKE AVE, SUITE 225, PASADENA, CA 91101
(626) 792-9949
(818) 952-5360
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
Primary
—
—
2084P0800X
Psychiatry Physician
C35318
CA
2084P0804X
Child & Adolescent Psychiatry Physician
C35318
CA
Other
Enumeration date
09/29/2006
Last updated
10/06/2009
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