Healthcare Provider Details

I. General information

NPI: 1043825235
Provider Name (Legal Business Name): KYLA ROCKLAND-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

1438 FLORIDA ST
SAN FRANCISCO CA
94110-4812
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2929
  • Fax:
Mailing address:
  • Phone: 413-687-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95015432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: