Healthcare Provider Details

I. General information

NPI: 1922497817
Provider Name (Legal Business Name): MILLIESAAR RAMA FNP-C, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 SIERRA AVE STE E
FONTANA CA
92336-3329
US

IV. Provider business mailing address

742 W HIGHLAND AVE
SAN BERNARDINO CA
92405-3839
US

V. Phone/Fax

Practice location:
  • Phone: 909-356-4459
  • Fax:
Mailing address:
  • Phone: 909-881-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033927
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: