Provider Demographics
NPI:1396131009
Name:MILLS, SUSAN LYNN (MPH, RD, CHES)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNN
Last Name:MILLS
Suffix:
Gender:F
Credentials:MPH, RD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5718 RAVENSPUR DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3536
Mailing Address - Country:US
Mailing Address - Phone:424-254-6062
Mailing Address - Fax:
Practice Address - Street 1:5718 RAVENSPUR DR UNIT 106
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3536
Practice Address - Country:US
Practice Address - Phone:424-254-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6918174H00000X
CA809951133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No174H00000XOther Service ProvidersHealth Educator