Individual
MILES ELLIS PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
8283 GROVE AVE, #104, RANCHO CUCAMONGA, CA 91730
(909) 920-9906
(909) 920-4151
Mailing address
8283 GROVE AVE, #104, RANCHO CUCAMONGA, CA 91730
(909) 920-9906
(909) 920-4151
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
AU1139
CA
237600000X
Audiologist-Hearing Aid Fitter
HA2555
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AU0011390
—
CA
Enumeration date
03/08/2006
Last updated
07/08/2007
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