Provider Demographics
NPI:1295057248
Name:MILLER, VIRGINIA (FDN, RDHAP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:FDN, RDHAP
Other - Prefix:MRS
Other - First Name:GINNY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDHAP
Mailing Address - Street 1:182 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3634
Mailing Address - Country:US
Mailing Address - Phone:831-224-4011
Mailing Address - Fax:
Practice Address - Street 1:182 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3634
Practice Address - Country:US
Practice Address - Phone:831-224-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282124Q00000X
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No124Q00000XDental ProvidersDental Hygienist