MEDICARE: MILO SINI ATC, CSCS, PTA

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	2255A2300X	Athletic Trainer	890479	CA

General Provider Information

NPI Number	:	1588988968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILO SINI ATC, CSCS, PTA

Provider Business Mailing Address
First Line	:	7033 LA TIJERA
Second Line	:	J-102
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2169
Country	:	US
Telephone Number	:	310-237-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	7033 LA TIJERA
Second Line	:	J-102
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2169
Country	:	US
Telephone Number	:	310-237-5567
Fax Number	:

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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