Individual
DR. MIRA CANTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11500 NIMITZ AVE, LOS ANGELES, CA 90049-3566
(424) 832-8268
(424) 832-8270
Mailing address
11500 NIMITZ AVE, LOS ANGELES, CA 90049-3566
(424) 832-8268
(424) 832-8270
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A39040
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A39040
LICENCE
CA
Enumeration date
06/02/2006
Last updated
10/25/2011
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