Basic Information
Provider Information | |||||||||
NPI: | 1720164080 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MILLA | ||||||||
FirstName: | CARLOS | ||||||||
MiddleName: | EDUARDO | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 770 WELCH RD STE 350 | ||||||||
Address2: | STANFORD UNIVERSITY | ||||||||
City: | PALO ALTO | ||||||||
State: | CA | ||||||||
PostalCode: | 943041523 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6507238325 | ||||||||
FaxNumber: | 6507235201 | ||||||||
Practice Location | |||||||||
Address1: | 770 WELCH RD STE 350 | ||||||||
Address2: | STANFORD UNIVERSITY | ||||||||
City: | PALO ALTO | ||||||||
State: | CA | ||||||||
PostalCode: | 943041523 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6507238325 | ||||||||
FaxNumber: | 6507235201 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/30/2006 | ||||||||
LastUpdateDate: | 04/10/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | C52708 | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
ID | Type | State | Issuer | Description | 48-01819 | 01 |   | MEDICA CHOICE | OTHER | 7777470 | 05 | SD |   | MEDICAID | 10387 | 05 | ND |   | MEDICAID | 252319100 | 05 | MN |   | MEDICAID | 0243356 | 05 | OH |   | MEDICAID | 0501064 | 05 | IA |   | MEDICAID | HP21997 | 01 |   | HEALTH PARTNERS | OTHER | 01748847 | 05 | NY |   | MEDICAID | 48-74539 | 01 |   | MEDICA PRIMARY | OTHER | 32181800 | 05 | WI |   | MEDICAID | 8D478MI | 01 |   | BLUE CROSS BLUE SHIELD | OTHER | 106653 | 01 |   | UCARE | OTHER | 768265 | 01 |   | ARAZ | OTHER | 1012193 | 01 |   | PREFERRED ONE | OTHER |