Healthcare Provider Details

I. General information

NPI: 1124514401
Provider Name (Legal Business Name): HANNAH MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

IV. Provider business mailing address

2945 MCMILLAN AVE SUITE 240
SAN LUIS OBISPO CA
93401
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-4839
  • Fax:
Mailing address:
  • Phone: 805-439-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number40728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: