Healthcare Provider Details

I. General information

NPI: 1316861636
Provider Name (Legal Business Name): STACIA MILLS, MD, A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 E COLORADO BLVD UNIT 5361
PASADENA CA
91107-3847
US

IV. Provider business mailing address

3016 E COLORADO BLVD UNIT 5361
PASADENA CA
91107-3847
US

V. Phone/Fax

Practice location:
  • Phone: 510-393-2909
  • Fax: 626-413-3663
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STACIA MILLS
Title or Position: PRESIDENT
Credential: MD
Phone: 510-393-2909