Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A21438 | CA |
Y | 208600000X | Surgeon | A21438 | CA |
NPI | 1013006071 |
---|---|
Provider Name | Timothy A Miller |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 05/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A214380 | (05) | CA |