Healthcare Provider Details

I. General information

NPI: 1174582175
Provider Name (Legal Business Name): NICOLE G MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

150 MUIR RD VA MEDICAL CENTER
MARTINEZ CA
94553-4668
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax: 925-372-2830
Mailing address:
  • Phone: 25-372-2000
  • Fax: 925-372-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPYS: 14798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: