Healthcare Provider Details

I. General information

NPI: 1902108764
Provider Name (Legal Business Name): GLENN EDWARD MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 OCEAN AVENUE #720
SANTA MONICA CA
90401-2148
US

IV. Provider business mailing address

1431 OCEAN AVE APT 720
SANTA MONICA CA
90401-2148
US

V. Phone/Fax

Practice location:
  • Phone: 310-963-6433
  • Fax: 310-260-7976
Mailing address:
  • Phone: 310-963-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG 29077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG29077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: