Provider Demographics
NPI:1841223260
Name:MILLA, GLORIA R
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:R
Last Name:MILLA
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 1:1399 NW 17TH AVE STE 302B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2334
Mailing Address - Country:US
Mailing Address - Phone:305-325-8771
Mailing Address - Fax:
Practice Address - Street 1:1399 NW 17TH AVE STE 302 B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2334
Practice Address - Country:US
Practice Address - Phone:305-325-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM400296455060OtherDRIVER LICENSE