Healthcare Provider Details

I. General information

NPI: 1649281130
Provider Name (Legal Business Name): ETAN MILGROM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 W 34TH ST
LOS ANGELES CA
90089-0079
US

IV. Provider business mailing address

849 W 34TH ST
LOS ANGELES CA
90089-0079
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-0225
  • Fax:
Mailing address:
  • Phone: 213-740-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG59018
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG59018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: