Provider Demographics
NPI:1558400606
Name:MILLER, ELI JERRY (MD)
Entity Type:Individual
Prefix:MR
First Name:ELI
Middle Name:JERRY
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9834 GENESEE AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:LAJOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-455-7364
Mailing Address - Fax:858-455-0053
Practice Address - Street 1:9834 GENESEE AVE STE 420
Practice Address - Street 2:
Practice Address - City:LAJOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-455-7364
Practice Address - Fax:858-455-0053
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC355672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry