Provider Demographics
NPI:1508874926
Name:MILLER, JENNIFER ANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2110
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-0936
Mailing Address - Country:US
Mailing Address - Phone:619-378-7076
Mailing Address - Fax:
Practice Address - Street 1:23568 GREEN GLEN RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-5904
Practice Address - Country:US
Practice Address - Phone:619-378-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5283935OtherMEDI-CAL PROVIDER NUMBER