Provider Demographics
NPI:1922364488
Name:MILLER, SIHAM SOBHAN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SIHAM
Middle Name:SOBHAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6408
Mailing Address - Country:US
Mailing Address - Phone:619-764-9455
Mailing Address - Fax:
Practice Address - Street 1:4625 ACACIA AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6408
Practice Address - Country:US
Practice Address - Phone:619-764-9455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist