Healthcare Provider Details

I. General information

NPI: 1194463653
Provider Name (Legal Business Name): ANGELA D MILLS RVS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 KINGS WAY STE 440
ROYAL PALM BEACH FL
33411-1567
US

IV. Provider business mailing address

127 KINGS WAY
ROYAL PALM BEACH FL
33411-1567
US

V. Phone/Fax

Practice location:
  • Phone: 561-346-4511
  • Fax: 866-602-4994
Mailing address:
  • Phone: 561-346-4511
  • Fax: 866-602-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number00067522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: