| Samuel I Miles Md A Professional Corporation | |
|
12381 Wilshire Blvd Ste 200 Los Angeles CA 90025-1063 | |
| (310) 659-1674 | |
| (888) 451-2967 |
| Full Name | Samuel I Miles Md A Professional Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12381 Wilshire Blvd Ste 200, Los Angeles, California |
| Authorized Official Name and Position | Samuel I Miles (PRES) |
| Authorized Official Contact | 3106591674 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel I Miles Md A Professional Corporation 11901 Santa Monica Blvd # 532 Los Angeles CA 90025-2767 Ph: (310) 659-1674 | Samuel I Miles Md A Professional Corporation 12381 Wilshire Blvd Ste 200 Los Angeles CA 90025-1063 Ph: (310) 659-1674 |
| NPI Number | 1790977429 |
|---|---|
| Provider Enumeration Date | 08/16/2007 |
| Last Update Date | 12/23/2021 |
| Certification Date | 11/23/2021 |
| Medicare PECOS PAC ID | 6406016641 |
|---|---|
| Medicare Enrollment ID | O20120327000316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790977429 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G30941 (California) | Primary |
| Provider Name | Samuel I Miles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407911662 PECOS PAC ID: 7214197458 Enrollment ID: I20120327000340 |
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