Provider Demographics
NPI:1922298041
Name:REBECCA D MILLER MD
Entity Type:Organization
Organization Name:REBECCA D MILLER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-964-1514
Mailing Address - Street 1:1111 EAST OCEAN AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436
Mailing Address - Country:US
Mailing Address - Phone:805-736-2512
Mailing Address - Fax:805-736-3183
Practice Address - Street 1:1111 EAST OCEAN AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-736-2512
Practice Address - Fax:805-736-3183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBECCA D MILLER MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A55231207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A552310Medicaid
A55231AMedicare PIN
CA00A552310Medicaid