Provider Demographics
NPI:1720164080
Name:MILLA, CARLOS EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:MILLA
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 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:650-497-8000
Mailing Address - Fax:650-723-5201
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:650-723-5201
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52708208000000X, 2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7777470Medicaid
8D478MIOtherBLUE CROSS BLUE SHIELD
NY01748847Medicaid
MN252319100Medicaid
48-74539OtherMEDICA PRIMARY
768265OtherARAZ
IA0501064Medicaid
WI32181800Medicaid
HP21997OtherHEALTH PARTNERS
ND10387Medicaid
106653OtherUCARE
48-01819OtherMEDICA CHOICE
1012193OtherPREFERRED ONE
OH0243356Medicaid
MN252319100Medicaid
SD7777470Medicaid