Healthcare Provider Details

I. General information

NPI: 1407429327
Provider Name (Legal Business Name): MILES REUBEN PICUS MS, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST
BURBANK CA
91505-4504
US

IV. Provider business mailing address

181 S BUENA VISTA ST
BURBANK CA
91505-4504
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-4748
  • Fax:
Mailing address:
  • Phone: 818-748-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: