MEDICARE: LAURA MILLER PPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1013776806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MILLER PPS

Provider Business Mailing Address
First Line	:	6540 WENTWORTH SPRINGS RD
Second Line	:
City	:	GEORGETOWN
State	:	CA
Zip	:	95634-9701
Country	:	US
Telephone Number	:	530-333-8300
Fax Number	:	530-333-8303

Provider Business Practice Location Address
First Line	:	6540 WENTWORTH SPRINGS RD
Second Line	:
City	:	GEORGETOWN
State	:	CA
Zip	:	95634-9701
Country	:	US
Telephone Number	:	530-333-8300
Fax Number	:	530-333-8303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2024
Last Update Date	:	03/15/2024

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Directions to “ LAURA MILLER PPS” Practice Location

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