Provider Demographics
NPI:1639856248
Name:MILES, ANTIONETTE
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:MILES
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 1:17319 SAN PEDRO AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1444
Mailing Address - Country:US
Mailing Address - Phone:702-329-7287
Mailing Address - Fax:
Practice Address - Street 1:17319 SAN PEDRO AVE STE 510
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1444
Practice Address - Country:US
Practice Address - Phone:702-329-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician