Individual
CARISSA RAE VAN MIERLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23961 CALLE DE LA MAGDALENA STE 119, LAGUNA HILLS, CA 92653-3616
(949) 837-5111
Mailing address
2 DAYLILY, RANCHO SANTA MARGARITA, CA 92688-1442
(949) 290-1079
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
CA
Other
Enumeration date
11/14/2021
Last updated
11/14/2021
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