Healthcare Provider Details

I. General information

NPI: 1679019053
Provider Name (Legal Business Name): RONALD MILLS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 INTERNATIONAL BLVD
OAKLAND CA
94621-2843
US

IV. Provider business mailing address

7501 INTERNATIONAL BLVD
OAKLAND CA
94621-2843
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax: 510-569-4965
Mailing address:
  • Phone: 510-835-9610
  • Fax: 510-569-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: