Healthcare Provider Details

I. General information

NPI: 1689314486
Provider Name (Legal Business Name): GEOFFREY MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N SPRING ST FL 16
LOS ANGELES CA
90012-4801
US

IV. Provider business mailing address

200 N SPRING ST FL 16
LOS ANGELES CA
90012-4801
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP23527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: