Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A73408 | CA |
NPI | 1316958085 |
---|---|
Provider Name | Travis Aaron Miller |
First Address | Sacramento, CA 95815-4314 |
Second Address | Roseville, CA 95661-3047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 19/10/2015 |