Provider Demographics
NPI:1871828533
Name:MILES, RUSSELL JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:JAMES
Last Name:MILES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3941 SAN DIMAS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5711
Mailing Address - Country:US
Mailing Address - Phone:661-324-6593
Mailing Address - Fax:661-324-3680
Practice Address - Street 1:875 BLAKE WILBUR DRIVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94305
Practice Address - Country:US
Practice Address - Phone:650-724-6480
Practice Address - Fax:650-724-7091
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19738363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical