Provider Demographics
NPI:1922456714
Name:MILLER, JAMIE E (LAC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
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 1:2646 FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5346
Mailing Address - Country:US
Mailing Address - Phone:831-331-5598
Mailing Address - Fax:
Practice Address - Street 1:2840 PARK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2866
Practice Address - Country:US
Practice Address - Phone:831-331-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist