Healthcare Provider Details

I. General information

NPI: 1255246591
Provider Name (Legal Business Name): MILES VINCENT CARUSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAGNOLIA ST UNIT 101
BELLINGHAM WA
98225-4580
US

IV. Provider business mailing address

3805 ELWOOD AVE UNIT 132
BELLINGHAM WA
98229-7688
US

V. Phone/Fax

Practice location:
  • Phone: 360-820-5835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: