Provider Demographics
NPI:1316036759
Name:MILLER, ROBERT M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1668
Mailing Address - Country:US
Mailing Address - Phone:626-795-7966
Mailing Address - Fax:626-795-7966
Practice Address - Street 1:575 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1668
Practice Address - Country:US
Practice Address - Phone:626-795-7966
Practice Address - Fax:626-795-7966
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP20630AOtherPPIN
CAQ65321Medicare UPIN