Provider Demographics
NPI:1336275841
Name:REID, MILES (LAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BARRINGTON AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5363
Mailing Address - Country:US
Mailing Address - Phone:310-231-3500
Mailing Address - Fax:310-231-3570
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-231-3500
Practice Address - Fax:310-231-3570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist