Provider Demographics
NPI:1568550242
Name:MILLS, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31852 PAC COAST HWY
Mailing Address - Street 2:SUITE #401
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6764
Mailing Address - Country:US
Mailing Address - Phone:949-499-2800
Mailing Address - Fax:949-499-9590
Practice Address - Street 1:31852 PAC COAST HWY
Practice Address - Street 2:SUITE #401
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-499-2800
Practice Address - Fax:949-499-9590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56260208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG56260AMedicare PIN