Provider Demographics
NPI:1376805382
Name:MILLAN, EVELIA (LMT)
Entity Type:Individual
Prefix:
First Name:EVELIA
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 S CALLE PRIMAVERA
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-2228
Mailing Address - Country:US
Mailing Address - Phone:928-750-5823
Mailing Address - Fax:
Practice Address - Street 1:1355 W 16TH ST
Practice Address - Street 2:STE 7
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4499
Practice Address - Country:US
Practice Address - Phone:928-750-5823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-16145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist