Provider Demographics
NPI:1477846863
Name:MILLER, DEMARA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMARA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEMARA
Other - Middle Name:NICOLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-541-7800
Mailing Address - Fax:707-573-5428
Practice Address - Street 1:131 STONY CIR STE 1600
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9520
Practice Address - Country:US
Practice Address - Phone:707-541-7800
Practice Address - Fax:707-573-5428
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA143444OtherSTATE MEDICAL LICENSE