Provider Demographics
NPI:1457959819
Name:MILES, DONALD G III
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:MILES
Suffix:III
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 1:24650 AMADOR ST APT 55
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1344
Mailing Address - Country:US
Mailing Address - Phone:971-666-1254
Mailing Address - Fax:
Practice Address - Street 1:795 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1243
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-12-08
Deactivation Date:2020-10-16
Deactivation Code:
Reactivation Date:2020-12-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician