Healthcare Provider Details

I. General information

NPI: 1528529161
Provider Name (Legal Business Name): ANNA MILLIREN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 11/27/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVID GRANT USAF MEDICAL CENTER 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3000
  • Fax:
Mailing address:
  • Phone: 707-423-3000
  • Fax: 571-376-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: