Provider Demographics
NPI:1972651172
Name:MILLER, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1585
Mailing Address - Country:US
Mailing Address - Phone:510-653-9730
Mailing Address - Fax:925-256-6466
Practice Address - Street 1:5625 COLLEGE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1585
Practice Address - Country:US
Practice Address - Phone:510-653-9730
Practice Address - Fax:925-256-6466
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL132490Medicare UPIN