Healthcare Provider Details

I. General information

NPI: 1992796064
Provider Name (Legal Business Name): JILL C MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16337 EVERHART DR
WEED CA
96094
US

IV. Provider business mailing address

16337 EVERHART DR
WEED CA
96094-9400
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-2297
  • Fax: 530-938-0494
Mailing address:
  • Phone: 530-938-2297
  • Fax: 530-938-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG86655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: