Mia Dominique Manipud, NP
Nurse Practitioner, Family in Santa Clara, CA. Individual provider (NPI-1).
NPI number1316630403
StatusActive
Last updated in NPPESJun 2, 2023
Details
- NPI
- 1316630403
- Entity type
- Individual (NPI-1)
- Name
- Mia Dominique Manipud
- Credential
- NP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 2, 2023
- Certification date
- Jun 2, 2023
- Last updated
- Jun 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 95024700 | CA | Yes |
Practice location
900 Lafayette St Ste 105Santa Clara, CA 95050-4966
Phone 408-293-7767
Mailing address
Po Box 31396Walnut Creek, CA 94598-8396
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