Healthcare Provider Details

I. General information

NPI: 1063801314
Provider Name (Legal Business Name): DAPHNE MILLER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 SANCHEZ ST
SAN FRANCISCO CA
94114-3833
US

IV. Provider business mailing address

1286 SANCHEZ ST
SAN FRANCISCO CA
94114-3833
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-0333
  • Fax: 415-642-6233
Mailing address:
  • Phone: 415-642-0333
  • Fax: 415-642-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG79443
License Number StateCA

VIII. Authorized Official

Name: DR. DAPHNE MILLER
Title or Position: OWNER
Credential: M.D.
Phone: 415-642-0333