Basic Information
Provider Information
NPI: 1710104617
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: ANN
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: MD, PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 9TH ST STE 150
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958146476
CountryCode: US
TelephoneNumber: 9166519476
FaxNumber: 9166518908
Practice Location
Address1: 10333 EL CAMINO REAL
Address2:  
City: ATASCADERO
State: CA
PostalCode: 934225808
CountryCode: US
TelephoneNumber: 8054682000
FaxNumber: 8054666011
Other Information
ProviderEnumerationDate: 04/20/2007
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084F0202X128580CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry

No ID Information.


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