1720164080 NPI number — DR. CARLOS EDUARDO MILLA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720164080 NPI number — DR. CARLOS EDUARDO MILLA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MILLA

Provider First Name:

CARLOS

Provider Middle Name:

EDUARDO

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1720164080

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/10/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

770 WELCH RD STE 350

Provider Second Line Business Mailing Address:

STANFORD UNIVERSITY

Provider Business Mailing Address City Name:

PALO ALTO

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

94304-1523

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

650-723-8325

Provider Business Mailing Address Fax Number:

650-723-5201

Provider First Line Business Practice Location Address:

770 WELCH RD STE 350

Provider Second Line Business Practice Location Address:

STANFORD UNIVERSITY

Provider Business Practice Location Address City Name:

PALO ALTO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

94304-1523

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

650-723-8325

Provider Business Practice Location Address Fax Number:

650-723-5201

Provider Enumeration Date:

10/30/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0214X , with the licence number:  C52708 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 48-01819 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7777470 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 10387 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 252319100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 0243356 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 0501064 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: HP21997 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 01748847 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 48-74539 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
• Identifier: 32181800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 8D478MI . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 106653 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 768265 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
• Identifier: 1012193 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".