Healthcare Provider Details

I. General information

NPI: 1730579483
Provider Name (Legal Business Name): LORI MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 INDUSTRIAL RD STE B
SAN CARLOS CA
94070-4152
US

IV. Provider business mailing address

957 INDUSTRIAL RD STE B
SAN CARLOS CA
94070-4152
US

V. Phone/Fax

Practice location:
  • Phone: 650-630-0981
  • Fax: 650-620-9549
Mailing address:
  • Phone: 650-630-0981
  • Fax: 650-620-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: