Healthcare Provider Details

I. General information

NPI: 1821393224
Provider Name (Legal Business Name): ERIC DEAN MILLER L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WILSHIRE BLVD STE 315
SANTA MONICA CA
90401-1883
US

IV. Provider business mailing address

900 WILSHIRE BLVD STE 315
SANTA MONICA CA
90401-1883
US

V. Phone/Fax

Practice location:
  • Phone: 310-913-1317
  • Fax: 310-434-2424
Mailing address:
  • Phone: 310-913-1317
  • Fax: 310-434-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberAC 9235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: