Healthcare Provider Details

I. General information

NPI: 1063096980
Provider Name (Legal Business Name): RAMONA MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 DALLAS ST
LA MESA CA
91942-3119
US

IV. Provider business mailing address

8536 DALLAS ST
LA MESA CA
91942-3119
US

V. Phone/Fax

Practice location:
  • Phone: 619-504-6658
  • Fax:
Mailing address:
  • Phone: 619-504-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH40435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: