1548630643 NPI number — STEVEN A MILES, M.D., A PROFESSIONAL CORPORATION

Table of content: MS. STEPHANIE HEBERT BOUDREAUX PMHNP (NPI 1710710298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548630643 NPI number — STEVEN A MILES, M.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN A MILES, M.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548630643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8631 WEST THIRD STREET
Provider Second Line Business Mailing Address:
SUITE 1017E
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-363-9221
Provider Business Mailing Address Fax Number:
424-208-0637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8631 WEST THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE 1017E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-363-9221
Provider Business Practice Location Address Fax Number:
424-208-0637
Provider Enumeration Date:
10/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MILES
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
ALOYSIUS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
424-363-9221

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  G48908 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com