Healthcare Provider Details

I. General information

NPI: 1609948769
Provider Name (Legal Business Name): MRS. MILA GASS II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 HOLLYWOOD BLVD
LOS ANGELES CA
90027-4909
US

IV. Provider business mailing address

5230 HOLLYWOOD BLVD
LOS ANGELES CA
90027-4909
US

V. Phone/Fax

Practice location:
  • Phone: 323-666-0949
  • Fax: 323-666-9317
Mailing address:
  • Phone: 323-666-0949
  • Fax: 323-666-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number101754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: