Provider Demographics
NPI:1528894730
Name:GARCIA, MILA S
Entity type:Individual
Prefix:
First Name:MILA
Middle Name:S
Last Name:GARCIA
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 1:23301 RIDGE ROUTE DR SPC 73
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1719
Mailing Address - Country:US
Mailing Address - Phone:949-463-0110
Mailing Address - Fax:
Practice Address - Street 1:23301 RIDGE ROUTE DR SPC 73
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1719
Practice Address - Country:US
Practice Address - Phone:949-463-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
CA202463716906343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)