MEDICARE: LARA PAULINE MILLER

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	235Z00000X	Speech-Language Pathologist	20136	CA

General Provider Information

NPI Number	:	1558793414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA PAULINE MILLER

Provider Business Mailing Address
First Line	:	3521 LOMITA BLVD
Second Line	:	SUITE 201
City	:	TORRANCE
State	:	CA
Zip	:	90505-5039
Country	:	US
Telephone Number	:	310-856-8528
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 LOMITA BLVD
Second Line	:	SUITE 201
City	:	TORRANCE
State	:	CA
Zip	:	90505-5039
Country	:	US
Telephone Number	:	310-856-8528
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ LARA PAULINE MILLER ” Practice Location

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