Provider Demographics
NPI:1801384102
Name:MILLS, LETICIA M
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24509 LOS ALISOS BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4234
Mailing Address - Country:US
Mailing Address - Phone:714-928-8226
Mailing Address - Fax:
Practice Address - Street 1:24509 LOS ALISOS BLVD APT 101
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4234
Practice Address - Country:US
Practice Address - Phone:714-928-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6627742347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle