Healthcare Provider Details

I. General information

NPI: 1710445283
Provider Name (Legal Business Name): WEST TOWER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 260W
LOS ANGELES CA
90048-6113
US

IV. Provider business mailing address

8635 W 3RD ST STE 260W
LOS ANGELES CA
90048-6113
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3324
  • Fax:
Mailing address:
  • Phone: 310-652-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD EDWARD MILLER
Title or Position: PARTNER
Credential: MD
Phone: 310-652-3324