Healthcare Provider Details

I. General information

NPI: 1154259729
Provider Name (Legal Business Name): HILLSIDE MOBILE PRIMARY CARE, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S SAN GORGONIO AVE STE 202
BANNING CA
92220-6015
US

IV. Provider business mailing address

12 S SAN GORGONIO AVE STE 202
BANNING CA
92220-6015
US

V. Phone/Fax

Practice location:
  • Phone: 818-237-7955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLY ANN MILLAN
Title or Position: CEO
Credential: NP
Phone: 818-237-7955