Provider Demographics
NPI:1417723610
Name:MILLER, RODNEY (LPT)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 W JULIEANN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-7542
Mailing Address - Country:US
Mailing Address - Phone:559-361-7192
Mailing Address - Fax:
Practice Address - Street 1:89 E MILL AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3808
Practice Address - Country:US
Practice Address - Phone:559-853-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37146167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician