Healthcare Provider Details

I. General information

NPI: 1700843893
Provider Name (Legal Business Name): LD MILLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD 234
REDLANDS CA
92373
US

IV. Provider business mailing address

101 E REDLANDS BLVD #234
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax: 909-335-3167
Mailing address:
  • Phone: 909-335-3026
  • Fax: 909-335-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: