MEDICARE: MIESHIA GASTON

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1497305684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIESHIA GASTON

Provider Business Mailing Address
First Line	:	831 LUCILE AVE
Second Line	:	201
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4265 S NORMANDIE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2324
Country	:	US
Telephone Number	:	213-949-1378
Fax Number	:

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

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	02/23/2023

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Directions to “ MIESHIA GASTON ” Practice Location

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