Provider Demographics
NPI:1659572360
Name:MILLER, SANDRA ANN (LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2514 CHALCEDONY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2332
Mailing Address - Country:US
Mailing Address - Phone:619-312-7777
Mailing Address - Fax:909-885-5818
Practice Address - Street 1:155 W HOSPITALITY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3305
Practice Address - Country:US
Practice Address - Phone:619-312-7777
Practice Address - Fax:909-885-5818
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist