Healthcare Provider Details

I. General information

NPI: 1194932145
Provider Name (Legal Business Name): ELIZABETH MILETI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 S. MARYLAND PKWAY #309
LAS VEGAS NV
89109
US

IV. Provider business mailing address

3196 S. MARYLAND PKWAY #309
LAS VEGAS NV
89109
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-0477
  • Fax: 702-791-6831
Mailing address:
  • Phone: 702-791-0477
  • Fax: 702-791-6831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTC58002004
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD01617
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: