Active NPI
Eliseo Mills Jr., MD
- Psychiatry Physician
- Montebello, CA
National Provider Identifier
1972895928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A40310
- Practice address
- 101 E Beverly Blvd
Suite 400
Montebello, CA 90640-4300 - Phone
- (323) 722-2928
- Fax
- (323) 722-1894
- NPI assigned
- Nov 23, 2005
- Reactivated
- May 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A40310 | CA | Primary |
Addresses
Primary practice location
101 E Beverly Blvd
Suite 400
Montebello, CA 90640-4300
Mailing address
101 E Beverly Blvd
Suite 400
Montebello, CA 90640-4300
Phone (323) 722-2928
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A403101 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2025 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40310 | CA | MD | Pharmacist |
| A40310 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1972895928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 E BEVERLY BLVD",
"address_2": "SUITE 400",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906404300",
"telephone_number": "323-722-2928",
"fax_number": "323-722-1894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E BEVERLY BLVD",
"address_2": "SUITE 400",
"city": "MONTEBELLO",
"state": "CA",
"postal_code": "906404300",
"telephone_number": "323-722-2928",
"fax_number": "323-722-1894"
}
],
"practiceLocations": [],
"basic": {
"replacement_npi": "1972895928",
"last_name": "MILLS",
"first_name": "ELISEO",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2023-03-07",
"deactivation_date": "2011-04-19",
"reactivation_date": "2011-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A40310",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A403101",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montebello, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.