Healthcare Provider Details

I. General information

NPI: 1275249963
Provider Name (Legal Business Name): MARISSA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 09/17/2026
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 PARAMOUNT BLVD STE 306
DOWNEY CA
90241-3324
US

IV. Provider business mailing address

10800 PARAMOUNT BLVD STED 306
DOWNEY CA
90241-3331
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax:
Mailing address:
  • Phone: 562-821-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: