Provider Demographics
NPI:1558846444
Name:MILES, MARQUI
Entity Type:Individual
Prefix:
First Name:MARQUI
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 SILVERSTREAM AVE APT 2077
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1173
Mailing Address - Country:US
Mailing Address - Phone:513-293-9470
Mailing Address - Fax:
Practice Address - Street 1:6661 SILVERSTREAM AVE APT 2077
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1173
Practice Address - Country:US
Practice Address - Phone:513-293-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1406116561OtherDRIVER LICENSE