Healthcare Provider Details

I. General information

NPI: 1952076630
Provider Name (Legal Business Name): ANTHONY MARTIN MILLS M D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 S BROADWAY
LOS ANGELES CA
90003-3319
US

IV. Provider business mailing address

8601 S BROADWAY
LOS ANGELES CA
90003-3319
US

V. Phone/Fax

Practice location:
  • Phone: 323-905-5675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY MARTIN MILLS
Title or Position: CEO
Credential:
Phone: 310-550-1010