Healthcare Provider Details

I. General information

NPI: 1851006431
Provider Name (Legal Business Name): RUTHA MAE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14614 VICTORY BLVD
VAN NUYS CA
91411-1621
US

IV. Provider business mailing address

14614 VICTORY BLVD
VAN NUYS CA
91411-1621
US

V. Phone/Fax

Practice location:
  • Phone: 747-264-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: