| NPI | 1235311598 |
|---|---|
| Former Name | MIA PAIGE FANGUY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200072) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04871) |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2012-01-27 |