Provider Demographics
NPI:1366478398
Name:MILLS, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL STE 217
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3084
Mailing Address - Country:US
Mailing Address - Phone:858-481-1151
Mailing Address - Fax:858-481-1333
Practice Address - Street 1:12395 EL CAMINO REAL STE 217
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3084
Practice Address - Country:US
Practice Address - Phone:858-481-1151
Practice Address - Fax:858-481-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG525372080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine