Healthcare Provider Details

I. General information

NPI: 1316995426
Provider Name (Legal Business Name): SANFORD JACK MILNER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACK MILNER D.P.M.

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LAS POSAS RD #201
CAMARILLO CA
93010-1505
US

IV. Provider business mailing address

3901 LAS POSAS RD #201
CAMARILLO CA
93010-1501
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-1333
  • Fax: 805-482-4374
Mailing address:
  • Phone: 805-484-1333
  • Fax: 805-482-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE1717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: