Provider Demographics
NPI:1609948769
Name:GASS, MILA II
Entity Type:Individual
Prefix:MRS
First Name:MILA
Middle Name:
Last Name:GASS
Suffix:II
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 1:5230 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-4909
Mailing Address - Country:US
Mailing Address - Phone:323-666-0949
Mailing Address - Fax:323-666-9317
Practice Address - Street 1:5230 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-4909
Practice Address - Country:US
Practice Address - Phone:323-666-0949
Practice Address - Fax:323-666-9317
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101754171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02318FMedicaid
CADME02318FMedicaid