Healthcare Provider Details

I. General information

NPI: 1639292402
Provider Name (Legal Business Name): PAMELA MILLER L:AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E. WALNUT ST. SUITE 305
PASADENA CA
91101
US

IV. Provider business mailing address

P.O. BOX 1427
MONROVIA CA
91017
US

V. Phone/Fax

Practice location:
  • Phone: 626-755-9864
  • Fax: 800-279-9342
Mailing address:
  • Phone: 626-755-9864
  • Fax: 800-279-9342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC3644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: