Provider Demographics
NPI:1639252745
Name:MILLER, LOVERA WOLF (MD)
Entity Type:Individual
Prefix:
First Name:LOVERA
Middle Name:WOLF
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST STE 250
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2909
Mailing Address - Country:US
Mailing Address - Phone:707-253-1135
Mailing Address - Fax:707-963-5083
Practice Address - Street 1:1100 TRANCAS ST STE 250
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2909
Practice Address - Country:US
Practice Address - Phone:707-253-1135
Practice Address - Fax:707-963-5083
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37894207VG0400X
IN01035794A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100164310Medicaid
P00439655OtherMEDICARE RR
IN000000775661OtherANTHEM BCBS
IN100164310Medicaid