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Individual

JESSE N MILLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1260 15TH ST, SUITE 1200, SANTA MONICA, CA 90404-1135
(310) 451-8751
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
138171
CA
208800000X
Urology Physician
44919
CO
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
138171
CA
2088P0231X
Pediatric Urology Physician
138171
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
138171
MEDICAL LICENSE
CA
05
25385763
CO
01
P00647968
RAILROAD MEDICARE
CO
Enumeration date
01/26/2007
Last updated
11/10/2015
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