MEDICARE: MR. BENNIE-JOHN MILAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	54020	CA

General Provider Information

NPI Number	:	1093258956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENNIE-JOHN MILAN PA-C

Provider Business Mailing Address
First Line	:	8352 HAZELTINE AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3758
Country	:	US
Telephone Number	:	818-974-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	8352 HAZELTINE AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-3758
Country	:	US
Telephone Number	:	818-974-1915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	11/28/2016

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