Provider Demographics
NPI:1356500987
Name:MILLA PEDIATRICS AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:MILLA PEDIATRICS AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-332-6644
Mailing Address - Street 1:6400 W NEWBERRY RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6605
Mailing Address - Country:US
Mailing Address - Phone:352-332-6644
Mailing Address - Fax:352-332-8251
Practice Address - Street 1:1847 SW BARNETT WAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6957
Practice Address - Country:US
Practice Address - Phone:386-755-2240
Practice Address - Fax:386-755-6598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLA PEDIATRICS AND ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00582622080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375159701Medicaid