Provider Demographics
NPI:1023219102
Name:MILLER, RONETTE (CAADE)
Entity Type:Individual
Prefix:MRS
First Name:RONETTE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CAADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5811
Mailing Address - Country:US
Mailing Address - Phone:619-588-1989
Mailing Address - Fax:619-588-6282
Practice Address - Street 1:1357 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5811
Practice Address - Country:US
Practice Address - Phone:619-588-1989
Practice Address - Fax:619-588-6282
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37ALMedicaid