Micah Ebanculla
Micah Ebanculla is a Student in an Organized Health Care Education/Training Program in Long Beach, California. Registered with an NPI since 2018.
- In the registry since
- 2018
- Specialties on file
- 2
Practice location Address checks out
1600 Atlantic AveLong Beach, CA 90813-2017
Phone: (562) 591-0581
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Specialties & licences
| Athletic Trainer (primary) | Taxonomy 2255A2300X |
|---|---|
| Student in an Organized Health Care Education/Training Program | Taxonomy 390200000X |
Record details
| NPI number | 1518469378 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | March 7, 2018 |
| Last updated in NPPES | May 3, 2021 |
| Certification date | April 22, 2021 |
| Mailing address | 5503 Pimenta Ave, Lakewood, CA 90712-1743 |
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