=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376805382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELIA MILLAN LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2012
-----------------------------------------------------
Last Update Date | 06/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1355 W 16TH ST STE 7
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-4499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-750-5823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1859 S CALLE PRIMAVERA
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85365-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-750-5823
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT-16145
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------