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NPI Code Detail

MEDICARE: LA KEISHA MILES

MEDICARE: LA KEISHA MILES
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-20-46651CA

General Provider Information

NPI Number : 1952818973
Entity Type Code : Individual
Provider Name (Legal Business Name) : LA KEISHA MILES
Provider Business Mailing Address
First Line : 14059 LA SALLE CT
Second Line :
City : FONTANA
State : CA
Zip : 92336-3503
Country : US
Telephone Number : 909-997-9221
Fax Number :
Provider Business Practice Location Address
First Line : 23046 AVENIDA DE LA CARLOTA STE 600
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1537
Country : US
Telephone Number : 714-504-5347
Fax Number : 888-403-6922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2017
Last Update Date : 03/12/2021

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Directions to “ LA KEISHA MILES ” Practice Location

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