Healthcare Provider Details

I. General information

NPI: 1699418129
Provider Name (Legal Business Name): ANTHONY G MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/30/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST CLINIC TOWER, SUITE A7D
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

3811 MONTEREY RD
LOS ANGELES CA
90032-1433
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-2324
  • Fax:
Mailing address:
  • Phone: 801-510-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA189410
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA189410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: