Healthcare Provider Details

I. General information

NPI: 1265796031
Provider Name (Legal Business Name): MILLA TUTMAN RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 TULLY RD
SAN JOSE CA
95111-1048
US

IV. Provider business mailing address

7122 MESA DR
APTOS CA
95003-3328
US

V. Phone/Fax

Practice location:
  • Phone: 408-494-1500
  • Fax: 408-494-1557
Mailing address:
  • Phone: 831-689-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number505053
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number505053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: