Healthcare Provider Details

I. General information

NPI: 1093357949
Provider Name (Legal Business Name): ANGELICA JANAE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W BROADWAY APT 2148
LONG BEACH CA
90802-9419
US

IV. Provider business mailing address

421 W BROADWAY APT 2148
LONG BEACH CA
90802-9419
US

V. Phone/Fax

Practice location:
  • Phone: 530-237-7755
  • Fax:
Mailing address:
  • Phone: 530-237-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number607
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: