Individual
MRS. PHONPRAPHA SITHAVADY MINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3171 VIA VIGANELLO, CHULA VISTA, CA 91914-5305
(818) 309-3330
Mailing address
3171 VIA VIGANELLO, CHULA VISTA, CA 91914-5305
(818) 309-3330
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B7087506
DRIVER LICENSE
CA
Enumeration date
09/20/2019
Last updated
09/20/2019
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