Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A148158 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A148158 | CA |
NPI | 1194137737 |
---|---|
Provider Name | Emily Miller |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 04/12/2019 |