Healthcare Provider Details

I. General information

NPI: 1184997744
Provider Name (Legal Business Name): MR. FLOYD MCMILLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3756 SANTA ROSALIA DR SUITE 417
LOS ANGELES CA
90008-3606
US

IV. Provider business mailing address

3756 SANTA ROSALIA DR SUITE 417
LOS ANGELES CA
90008-3606
US

V. Phone/Fax

Practice location:
  • Phone: 323-295-1136
  • Fax: 323-295-9067
Mailing address:
  • Phone: 323-295-1136
  • Fax: 323-295-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: