Provider Demographics
NPI:1508983859
Name:MILLER, LETICIA (RT,R)
Entity Type:Individual
Prefix:MS
First Name:LETICIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RT,R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 WHISPER FALLS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3539
Mailing Address - Country:US
Mailing Address - Phone:210-332-3936
Mailing Address - Fax:
Practice Address - Street 1:11331 WHISPER FALLS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3539
Practice Address - Country:US
Practice Address - Phone:210-332-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2370692471C3402X
NY4972582471C3402X
TX290542471C3402X
NJ6414262471C3402X
RIRAD015532471C3402X
OHR88541662471C3402X
CARHT856062471C3402X
MA116852471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography