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General NPI Number Information
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NPI Number | 1962732180
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Entity Type | Organization
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Legal Business Name | MADELINE L MILLER MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 2600 E COAST HWY SUITE 200
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2117
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Country | US
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Telephone | 949-721-4161
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Fax | 949-717-0137
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Provider Business Mailing Address
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Address Line | 2600 E COAST HWY SUITE 200
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City | CORONA DEL MAR
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State | CA
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Zip | 92625-2117
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Country | US
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Telephone | 949-721-4161
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Fax | 949-717-0137
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Authorized Official
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Title or Position | OWNER
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Name | DR. MADELINE MILLER
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Credential | M.D.
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Telephone | 949-721-4161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C50252
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License Number State | CA
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