Healthcare Provider Details

I. General information

NPI: 1235424599
Provider Name (Legal Business Name): CARLA CELICIA MILLS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WESTERN AVE STE 204
SAN BERNARDINO CA
92411-1353
US

IV. Provider business mailing address

1722 S CRESCENT HEIGHTS BLVD
LOS ANGELES CA
90035-4615
US

V. Phone/Fax

Practice location:
  • Phone: 909-474-9952
  • Fax:
Mailing address:
  • Phone: 323-494-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95013882
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number762762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: