Provider Demographics
NPI:1518996594
Name:FLEURY-MILFORT, EVELYNE (NP)
Entity Type:Individual
Prefix:MS
First Name:EVELYNE
Middle Name:
Last Name:FLEURY-MILFORT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWNP338A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11675OtherGROUP MEDICARE PIN
CA1356390009OtherGROUP NPI
CA500012246OtherRAILROAD MEDICARE
CAW18762OtherGROUP MEDICARE
CACE1617OtherGROUP RAILROAD MEDICARE
CARN382854Medicaid
CA1902846306OtherGROUP NPI
CAGR0016910OtherGROUP MEDICAID
CA3828540OtherBLUE SHIELD
CAGR0100430OtherGROUP MEDICAL
CAGR0016910OtherGROUP MEDICAID
CAP04568Medicare UPIN