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NPI Code Detail

MEDICARE: JESSICA I MILLER

MEDICARE: JESSICA I 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
1106H00000XMarriage & Family Therapist
2106E00000XAssistant Behavior Analyst

General Provider Information

NPI Number : 1871872341
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA I MILLER
Provider Business Mailing Address
First Line : 22336 CAMINITO ARROYO SECO
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1063 MCGAW AVE
Second Line :
City : IRVINE
State : CA
Zip : 92614-5505
Country : US
Telephone Number : 714-653-5097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2011
Last Update Date : 10/23/2020

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