Provider Demographics
NPI:1467862789
Name:MILLER, MIQUELL OLIVIA (MD, MSC)
Entity Type:Individual
Prefix:
First Name:MIQUELL
Middle Name:OLIVIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 STOCKTON BLVD, FLOOR 6
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-2620
Mailing Address - Fax:
Practice Address - Street 1:2335 STOCKTON BLVD, FLOOR 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143660208C00000X
PA74357208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery