Individual
MYLA GUANGCO BACALSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50083 MARGARET AVE, MACOMB, MI 48044-6340
(586) 412-0838
Mailing address
26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
(248) 577-3313
(248) 577-3302
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704200259
MI
Other
Enumeration date
04/17/2017
Last updated
02/04/2021
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