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General NPI Number Information
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NPI Number | 1710074877
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Entity Type | Organization
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Legal Business Name | MILL MEDICAL CLINIC INC
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 1292 W MILL ST SUITE 105
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-2500
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Country | US
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Telephone | 909-383-9440
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Fax | 909-383-9443
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Provider Business Mailing Address
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Address Line | 1292 W MILL ST SUITE 105
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City | SAN BERNARDINO
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State | CA
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Zip | 92410-2500
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Country | US
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Telephone | 909-253-0841
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Fax | 909-521-7154
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. PAUL C KINTANAR
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Credential |
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Telephone | 909-253-0841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A383760
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License Number State | CA
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