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General NPI Number Information
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NPI Number | 1629906177
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Entity Type | Organization
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Legal Business Name | MILLICENT LLC
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Dates
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Enumeration Date | 05/13/2026
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Last Update Date | 05/13/2026
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Provider Practice Location Address
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Address Line | 2220 SANTA FE DR
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City | FAIRFIELD
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State | CA
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Zip | 94533-2243
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Country | US
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Telephone | 707-246-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 HARRISBURG LN
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City | SUISUN CITY
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State | CA
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Zip | 94585-6335
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Country | US
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Telephone | 707-246-8719
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JANICE SANTIAGO DOMINGO
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Credential |
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Telephone | 707-246-8719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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