Provider Demographics
NPI:1245303247
Name:KITANE, MILAGROS TRIVINO
Entity type:Individual
Prefix:MRS
First Name:MILAGROS
Middle Name:TRIVINO
Last Name:KITANE
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 1:8700 WOODMAN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6553
Mailing Address - Country:US
Mailing Address - Phone:818-920-3700
Mailing Address - Fax:818-920-3722
Practice Address - Street 1:8700 WOODMAN AVE STE 6
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6553
Practice Address - Country:US
Practice Address - Phone:818-920-3700
Practice Address - Fax:818-920-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002165722-0001-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies