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1649991720
JUSTIN MIKESELL
THOUSAND OAKS, CA
NPI
1649991720
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CA 61471)
Additional Taxonomies
363A00000X Physician Assistant
Enumeration Date
2022-09-07
Last Update Date
2022-09-07
Business Address
JUSTIN MIKESELL
3095 OLD CONEJO RD STE 200
THOUSAND OAKS, CA 91320-2130
Phone number: 805-298-7034
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Mailing Address
JUSTIN MIKESELL
2012 S PUMP HOUSE LN
SANTA PAULA, CA 93060-8024
Phone number:
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