Provider Demographics
NPI:1831360221
Name:JACKSON-MILES, LENISHA DANIELLE (CMA)
Entity type:Individual
Prefix:MRS
First Name:LENISHA
Middle Name:DANIELLE
Last Name:JACKSON-MILES
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6664
Mailing Address - Country:US
Mailing Address - Phone:619-370-2197
Mailing Address - Fax:
Practice Address - Street 1:2051 CUSHING RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6173
Practice Address - Country:US
Practice Address - Phone:619-524-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2394412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical