Healthcare Provider Details

I. General information

NPI: 1811913320
Provider Name (Legal Business Name): MARILYN L MILLER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343-2036
US

IV. Provider business mailing address

2136 CROSSCREEK AVE
SIMI VALLEY CA
93063-5000
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-2856
  • Fax:
Mailing address:
  • Phone: 818-891-7711
  • Fax: 818-895-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number601003
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: