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Individual

CHARLES MICHAEL NILES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
23701 E EAST FORK RD, AZUSA, CA 91702-1477
(626) 250-3290
Mailing address
23701 E EAST FORK RD, AZUSA, CA 91702-1477
(626) 250-3290

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
02/03/2016
Last updated
02/03/2016
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