Healthcare Provider Details

I. General information

NPI: 1992059075
Provider Name (Legal Business Name): JEFFERY MILLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 OCEAN AVE
SAN FRANCISCO CA
94132-1616
US

IV. Provider business mailing address

2620 OCEAN AVE
SAN FRANCISCO CA
94132-1616
US

V. Phone/Fax

Practice location:
  • Phone: 415-333-3600
  • Fax: 415-333-7674
Mailing address:
  • Phone: 415-333-3600
  • Fax: 415-333-7674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY MILLER
Title or Position: OWNER
Credential:
Phone: 415-333-3600