Provider Demographics
NPI:1457071110
Name:MILLS, CHIMERE ALYASSA
Entity type:Individual
Prefix:
First Name:CHIMERE
Middle Name:ALYASSA
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 N SAM HOUSTON PKWY E STE 1020A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2492
Mailing Address - Country:US
Mailing Address - Phone:713-309-6779
Mailing Address - Fax:713-347-8734
Practice Address - Street 1:363 N SAM HOUSTON PKWY E STE 1020A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2492
Practice Address - Country:US
Practice Address - Phone:713-309-6779
Practice Address - Fax:713-347-8734
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC102007246RM2200X
SC60140246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory