Provider Demographics
NPI:1982775128
Name:MILLA PEDIATRICS AND ASSOCIATES, INC.
Entity type:Organization
Organization Name:MILLA PEDIATRICS AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-755-2240
Mailing Address - Street 1:426 SW COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1505
Mailing Address - Country:US
Mailing Address - Phone:386-755-2240
Mailing Address - Fax:386-755-6598
Practice Address - Street 1:426 SW COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1505
Practice Address - Country:US
Practice Address - Phone:386-755-2240
Practice Address - Fax:386-755-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375159701Medicaid
FL375159702Medicaid