Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 607 | CA |
NPI | 1093357949 |
---|---|
Provider Name | Angelica Janae Miller |
First Address | Long Beach, CA 90802-9419 |
Second Address | Long Beach, CA 90802-9419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2019 |
Last Update Date | 30/03/2020 |