Provider Demographics
NPI:1568413318
Name:MILLAN, JORGE JR (DPT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MILLAN
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 COBB MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1205
Mailing Address - Country:US
Mailing Address - Phone:619-540-8697
Mailing Address - Fax:
Practice Address - Street 1:264 LANDIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2651
Practice Address - Country:US
Practice Address - Phone:619-422-3991
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14508OtherGROUP
CAW14508OtherGROUP