Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | KK125494 | CA |
NPI | 1285113951 |
---|---|
Provider Name | Janet Miller |
First Address | San Diego, CA 92114 |
Second Address | San Diego, CA 92114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KK125494 | ALL COMMERCIAL INSURANCES (01) | CA |