Provider Demographics
NPI:1669954590
Name:MILLS, JANESSA MARTRESA
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:MARTRESA
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 1:10480 EL MERCADO DR # 78
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5908
Mailing Address - Country:US
Mailing Address - Phone:916-598-2224
Mailing Address - Fax:
Practice Address - Street 1:10480 EL MERCADO DR # 78
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5908
Practice Address - Country:US
Practice Address - Phone:916-598-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician