MIKEY THANTERAPHONG

SIMI VALLEY, CA
NPI1437795333
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: CA  95013063)
Enumeration Date2019-11-26
Last Update Date2025-09-25
Business Address
MIKEY THANTERAPHONG
2845 COCHRAN ST STE B
SIMI VALLEY, CA 93065-7905
Phone number: 818-835-7355
Mailing Address
MIKEY THANTERAPHONG
PO BOX 336
AGOURA HILLS, CA 91376-0336
Phone number: 818-835-7355