Doctor Name: | DR. TOMMY GLEN MILLADGE |
NPI Number: | 1699111575 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PSY9852 |
Business Practice Address: | 5456 Highbury Way Eastvale, CA - 917523690 |
Business Phone Number: | 9097208646 |
Business Fax Number: | |
Mailing Address: | 5456 Highbury Way, EASTVALE |
State: | CA |
Postal Code: | 917523690 |
Phone Number: | 9097208646 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2013 |
NPI Last Update Date: | 05/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | PSY9852 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |