Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | G59474 | CA |
NPI | 1053470591 |
---|---|
Provider Name | Dr. Lisa S Miller |
First Address | San Diego, CA 92123 |
Second Address | San Diego, CA 92123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001594740 | MEDICAL (01) | CA |