Provider Demographics
NPI:1639311764
Name:MILLER, MIA (MD)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2100 W 3RD ST
Mailing Address - Street 2:HOUSE CLINIC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1944
Mailing Address - Country:US
Mailing Address - Phone:213-483-9930
Mailing Address - Fax:213-484-5900
Practice Address - Street 1:8635 W 3RD ST STE 590W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6163
Practice Address - Country:US
Practice Address - Phone:310-423-1220
Practice Address - Fax:310-423-1230
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA103606208600000X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No208600000XAllopathic & Osteopathic PhysiciansSurgery