Healthcare Provider Details

I. General information

NPI: 1922456714
Provider Name (Legal Business Name): JAMIE E MILLER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 PARK AVE SUITE A
SOQUEL CA
95073-2866
US

IV. Provider business mailing address

2646 FRESNO ST
SANTA CRUZ CA
95062-5346
US

V. Phone/Fax

Practice location:
  • Phone: 831-331-5598
  • Fax:
Mailing address:
  • Phone: 831-331-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: