Healthcare Provider Details

I. General information

NPI: 1447445218
Provider Name (Legal Business Name): TAMMY PAULETTE MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CHESTNUT AVE ROOM 205
LONG BEACH CA
90813-2944
US

IV. Provider business mailing address

1333 CHESTNUT AVE ROOM 205
LONG BEACH CA
90813-2944
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-8635
  • Fax: 562-218-0853
Mailing address:
  • Phone: 562-599-8635
  • Fax: 562-218-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA062430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: