Healthcare Provider Details

I. General information

NPI: 1629992870
Provider Name (Legal Business Name): MISS AH-MILEON SHALESE GAYBRIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CENTURY PARK E
LOS ANGELES CA
90067-1907
US

IV. Provider business mailing address

2070 CENTURY PARK E
LOS ANGELES CA
90067-1907
US

V. Phone/Fax

Practice location:
  • Phone: 424-522-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number01352726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: