Provider Demographics
NPI:1407511900
Name:MILLER, DEBORAH J (CPCP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 DOVER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6935
Mailing Address - Country:US
Mailing Address - Phone:949-395-3300
Mailing Address - Fax:
Practice Address - Street 1:833 DOVER DR STE 4
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6935
Practice Address - Country:US
Practice Address - Phone:949-395-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPR0085181156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist