Individual
MR. MAINA MIRICHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
311 CUCKOO DR, SAN JACINTO, CA 92582-6986
(949) 887-0426
Mailing address
311 CUCKOO DR, SAN JACINTO, CA 92582-6986
(949) 887-0426
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95006392
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95006392
NURSE PRACTITIONER LICENSE
CA
Enumeration date
03/26/2017
Last updated
03/26/2017
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