Provider Demographics
NPI:1558517557
Name:MILLER, MIA BELTRAN (PT)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:BELTRAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MIA FIDES
Other - Middle Name:EDU
Other - Last Name:BELTRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:400 LUCERA CT
Mailing Address - Street 2:206
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-0908
Mailing Address - Country:US
Mailing Address - Phone:909-461-0821
Mailing Address - Fax:
Practice Address - Street 1:400 LUCERA CT
Practice Address - Street 2:206
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-0908
Practice Address - Country:US
Practice Address - Phone:909-461-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT34513OtherCA STATE LICENSE