Provider Demographics
NPI:1760537179
Name:ATZ, MILAGROS
Entity Type:Individual
Prefix:MS
First Name:MILAGROS
Middle Name:
Last Name:ATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAOTRL
Mailing Address - Street 1:37 PAULS PATH
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3721
Mailing Address - Country:US
Mailing Address - Phone:631-846-6727
Mailing Address - Fax:
Practice Address - Street 1:37 PAULS PATH
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3721
Practice Address - Country:US
Practice Address - Phone:631-846-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02753-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist