Healthcare Provider Details

I. General information

NPI: 1093789133
Provider Name (Legal Business Name): CHARLA K. MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E RAMBLING RD
COVINA CA
91724-3440
US

IV. Provider business mailing address

1400 E RAMBLING RD
COVINA CA
91724-3440
US

V. Phone/Fax

Practice location:
  • Phone: 818-332-6181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: