Provider Demographics
NPI:1710068085
Name:MILES, AIDA C (RD, CSP)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:C
Last Name:MILES
Suffix:
Gender:F
Credentials:RD, CSP
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 1711
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966
Mailing Address - Country:US
Mailing Address - Phone:415-332-6066
Mailing Address - Fax:415-332-6068
Practice Address - Street 1:7 CLOUDVIEW TRAIL
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965
Practice Address - Country:US
Practice Address - Phone:415-332-6066
Practice Address - Fax:415-332-6068
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA712332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered