Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G36498 | CA |
NPI | 1053463935 |
---|---|
Provider Name | Dr. Lester D Miller |
First Address | Santa Cruz, CA 95062-2203 |
Second Address | Santa Cruz, CA 95062-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G364980 | (05) | CA |
A46707 | (02) | CA |