Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | G28208 | CA |
NPI | 1073575353 |
---|---|
Provider Name | Mark P Miller |
First Address | Anaheim, CA 92801-2815 |
Second Address | Anaheim, CA 92801-2815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 09/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G282080 | (05) | CA |
A43648 | (02) | CA |
ZZZ098672 | BLUE SHIELD OF CALIF (01) | CA |