Provider Demographics
NPI:1093365488
Name:MILLS, AMANDA CANTILLER
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CANTILLER
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 FIRETHORN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2635
Mailing Address - Country:US
Mailing Address - Phone:619-581-9764
Mailing Address - Fax:
Practice Address - Street 1:804 FIRETHORN ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2635
Practice Address - Country:US
Practice Address - Phone:619-581-9764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider