Provider Demographics
NPI:1326480799
Name:ISLA, MILYNNDA GAITAN
Entity Type:Individual
Prefix:MRS
First Name:MILYNNDA
Middle Name:GAITAN
Last Name:ISLA
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 1:105 NORTH AVALON DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953
Mailing Address - Country:US
Mailing Address - Phone:740-632-7827
Mailing Address - Fax:
Practice Address - Street 1:105 AVALON ESTS
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3777
Practice Address - Country:US
Practice Address - Phone:740-632-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy