Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A135513 | CA |
NPI | 1255569968 |
---|---|
Provider Name | Justin David Millard |
First Address | Los Alamitos, CA 90720-3353 |
Second Address | Los Alamitos, CA 90720-3353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 21/06/2020 |