Provider Demographics
NPI:1982825568
Name:MILLER, DIANA C (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N RANCHO DE BOSQUE
Mailing Address - Street 2:
Mailing Address - City:LAMY
Mailing Address - State:NM
Mailing Address - Zip Code:87540-7573
Mailing Address - Country:US
Mailing Address - Phone:760-238-3158
Mailing Address - Fax:
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:STE M5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2106
Practice Address - Country:US
Practice Address - Phone:760-238-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-04192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91059Medicare UPIN