Provider Demographics
NPI:1942632948
Name:MILLER, ELIZABETH ANN (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MAILSTOP #66
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-4148
Mailing Address - Fax:323-361-3668
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MAILSTOP #66
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-4148
Practice Address - Fax:323-361-3668
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21094281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren