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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0214XC52708CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology

ID Information
IDTypeStateIssuerDescription
48-0181901 MEDICA CHOICEOTHER
777747005SD MEDICAID
1038705ND MEDICAID
25231910005MN MEDICAID
024335605OH MEDICAID
050106405IA MEDICAID
HP2199701 HEALTH PARTNERSOTHER
0174884705NY MEDICAID
48-7453901 MEDICA PRIMARYOTHER
3218180005WI MEDICAID
8D478MI01 BLUE CROSS BLUE SHIELDOTHER
10665301 UCAREOTHER
76826501 ARAZOTHER
101219301 PREFERRED ONEOTHER


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