Healthcare Provider Details

I. General information

NPI: 1053470591
Provider Name (Legal Business Name): LISA S MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST SUITE 406
SAN DIEGO CA
92123
US

IV. Provider business mailing address

8010 FROST ST SUITE 406
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-1899
  • Fax: 858-467-1363
Mailing address:
  • Phone: 858-467-1899
  • Fax: 858-467-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberG59474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: