Healthcare Provider Details

I. General information

NPI: 1871663948
Provider Name (Legal Business Name): CHRISTINE W. MILLER L.AC. & DIPL. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4754 PALM AVE
LA MESA CA
91941-5253
US

IV. Provider business mailing address

3653 AVOCADO VILLAGE CT UNIT 111
LA MESA CA
91941-8320
US

V. Phone/Fax

Practice location:
  • Phone: 619-302-1129
  • Fax:
Mailing address:
  • Phone: 619-302-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number021436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: