Provider Demographics
NPI:1346430493
Name:MILLER, VICKY ANN (LPT, LVN CADC)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPT, LVN CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 ETIWANDA AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9662
Mailing Address - Country:US
Mailing Address - Phone:909-463-5077
Mailing Address - Fax:909-986-0941
Practice Address - Street 1:317 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3205
Practice Address - Country:US
Practice Address - Phone:909-986-7111
Practice Address - Fax:909-986-0941
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA084376101YA0400X
104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker