Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 39290 | CA |
NPI | 1003262528 |
---|---|
Provider Name | Dr. Asa Cedric Mills |
First Address | Fallbrook, CA 92028-9713 |
Second Address | Temecula, CA 92592-6826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2016 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39290 | CALIFORNIA PHYSICAL THERAPY BOARD (01) | CA |