Provider Demographics
NPI:1922805571
Name:MILES, TYKENO DUPREE (AS, AA)
Entity type:Individual
Prefix:
First Name:TYKENO
Middle Name:DUPREE
Last Name:MILES
Suffix:
Gender:M
Credentials:AS, AA
Other - Prefix:
Other - First Name:TYKENO
Other - Middle Name:DUPREE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DIRECT SUPPORT
Mailing Address - Street 1:2442 SANTA ANA N
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2106
Mailing Address - Country:US
Mailing Address - Phone:424-213-9143
Mailing Address - Fax:323-537-4295
Practice Address - Street 1:2442 SANTA ANA N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2106
Practice Address - Country:US
Practice Address - Phone:424-213-9143
Practice Address - Fax:323-537-4295
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6058246735251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services