Healthcare Provider Details

I. General information

NPI: 1245383835
Provider Name (Legal Business Name): LARRY C MILHOLIN C.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 LUCILE AVE SUITE B
STOCKTON CA
95209-4703
US

IV. Provider business mailing address

1955 LUCILE AVE SUITE B
STOCKTON CA
95209-4703
US

V. Phone/Fax

Practice location:
  • Phone: 209-639-7942
  • Fax: 209-951-0448
Mailing address:
  • Phone: 209-639-7942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: