MEDICARE: ALISSA A MILLER RD, LD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT81522	TX
2	133V00000X	Registered Dietitian	1038969	TX

General Provider Information

NPI Number	:	1063853679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA A MILLER RD, LD, CDE

Provider Business Mailing Address
First Line	:	2525 ROBINHOOD ST STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2573
Country	:	US
Telephone Number	:	713-800-6679
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 ROBINHOOD ST STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2573
Country	:	US
Telephone Number	:	713-800-6679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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