Provider Demographics
NPI:1356329874
Name:MILBURN, ANDRE LAMONT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:LAMONT
Last Name:MILBURN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 3RD STREET
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1648
Mailing Address - Country:US
Mailing Address - Phone:213-935-8795
Mailing Address - Fax:213-935-8786
Practice Address - Street 1:420 E 3RD STREET
Practice Address - Street 2:SUITE 1005
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1648
Practice Address - Country:US
Practice Address - Phone:213-935-8795
Practice Address - Fax:213-895-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3290367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered