Provider Demographics
NPI:1215433982
Name:MILLA, MARLENI FABIOLA (MD)
Entity type:Individual
Prefix:
First Name:MARLENI
Middle Name:FABIOLA
Last Name:MILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLENI
Other - Middle Name:FABIOLA
Other - Last Name:MILLA MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030
Mailing Address - Country:US
Mailing Address - Phone:860-679-6700
Mailing Address - Fax:860-679-6736
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-6410
Practice Address - Country:US
Practice Address - Phone:860-679-6700
Practice Address - Fax:860-679-6736
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0754152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program