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General NPI Number Information
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NPI Number | 1295355303
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Entity Type | Individual
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Provider Name | MAX AKIHIRO MACMILLAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 10862 CALLE VERDE
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City | LA MESA
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State | CA
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Zip | 91941-7340
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Country | US
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Telephone | 619-670-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 619-670-5400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A186038
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License Number State | CA
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