Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G17782 | CA |
NPI | 1164599189 |
---|---|
Provider Name | Mario Milch |
First Address | Los Angeles, CA 90027-6021 |
Second Address | Los Angeles, CA 90027-6021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 23/09/2008 |