Healthcare Provider Details

I. General information

NPI: 1033583067
Provider Name (Legal Business Name): MELINDA REBECCA MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SAN ANTONIO RD
MOUNTAIN VIEW CA
94040-1209
US

IV. Provider business mailing address

225 SAN ANTONIO RD
MOUNTAIN VIEW CA
94040-1209
US

V. Phone/Fax

Practice location:
  • Phone: 650-948-0807
  • Fax:
Mailing address:
  • Phone: 650-948-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number777115
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: