Provider Demographics
NPI:1376988840
Name:MINTSIS, MILA ALEXANDRA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MILA
Middle Name:ALEXANDRA
Last Name:MINTSIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:95 UNIVERSITY PL FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4515
Mailing Address - Country:US
Mailing Address - Phone:212-604-1316
Mailing Address - Fax:646-291-8025
Practice Address - Street 1:95 UNIVERSITY PL FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4515
Practice Address - Country:US
Practice Address - Phone:212-604-1316
Practice Address - Fax:646-291-8025
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist