Basic Information
| Provider Information | |||||||||
| NPI: | 1316683147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILZ | ||||||||
| FirstName: | THALIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 N 48TH AVE | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330214134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546734506 | ||||||||
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| Practice Location | |||||||||
| Address1: | 374 STOCKHOLM ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189637272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2022 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | P114005 | NY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | P114005 | NY | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.