Provider Demographics
NPI:1396585394
Name:MILTON, WILLIE TIYON
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:TIYON
Last Name:MILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALLEN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553
Mailing Address - Country:US
Mailing Address - Phone:925-995-3944
Mailing Address - Fax:
Practice Address - Street 1:25 ALLEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94552
Practice Address - Country:US
Practice Address - Phone:925-515-1923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker