Healthcare Provider Details

I. General information

NPI: 1699897124
Provider Name (Legal Business Name): MARCELA MILLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CRANE ST
MENLO PARK CA
94025-4260
US

IV. Provider business mailing address

1300 CRANE ST
MENLO PARK CA
94025-4260
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7489
  • Fax: 650-322-0966
Mailing address:
  • Phone: 650-498-7489
  • Fax: 650-322-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC128192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: