Provider Demographics
NPI:1336295526
Name:MILES-SMITH, OSCAR DELBERT JR (PA)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:DELBERT
Last Name:MILES-SMITH
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:OSCAR
Other - Middle Name:DELBERT
Other - Last Name:SMITH
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2051 MARENGO STREET
Mailing Address - Street 2:LAC USC MEDICAL CENTER, IPT ROOM C1A113
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-409-6715
Mailing Address - Fax:323-441-8309
Practice Address - Street 1:2051 MARENGO STREET
Practice Address - Street 2:LAC USC MEDICAL CENTER, IPT ROOM C1A113
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-409-6715
Practice Address - Fax:323-441-8309
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant