Provider Demographics
NPI:1417631003
Name:WARNER, MILTONIA ANTOINETTE
Entity Type:Individual
Prefix:
First Name:MILTONIA
Middle Name:ANTOINETTE
Last Name:WARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 260TH ST UNIT 27
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3923
Mailing Address - Country:US
Mailing Address - Phone:703-498-7908
Mailing Address - Fax:
Practice Address - Street 1:1444 260TH ST UNIT 27
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3923
Practice Address - Country:US
Practice Address - Phone:703-498-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily