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General NPI Number Information
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NPI Number | 1184830218
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Entity Type | Individual
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Provider Name | SANDRA NICKOLE MILLER RD,CDE
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1911 JOHNSON AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4131
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Country | US
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Telephone | 805-542-6229
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SURF ST
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City | PISMO BEACH
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State | CA
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Zip | 93449-2811
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Country | US
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Telephone | 805-440-7688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 281P00000X
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Taxonomy Name | Chronic Disease Hospital
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License Number |
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License Number State |
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