Provider Demographics
NPI:1972895928
Name:MILLS, ELISEO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ELISEO
Middle Name:
Last Name:MILLS
Suffix:JR
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 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4300
Mailing Address - Country:US
Mailing Address - Phone:323-722-2928
Mailing Address - Fax:323-722-1894
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-722-2928
Practice Address - Fax:323-722-1894
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:2011-04-19
Deactivation Code:
Reactivation Date:2011-05-10
Provider Licenses
StateLicense IDTaxonomies
CAA403102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A403101Medicaid
CA00A403101Medicaid
A85432Medicare UPIN
CA00A403101Medicaid