Provider Demographics
NPI:1447930383
Name:MILLER, JESSICA LAUREN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 FAY AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4280
Mailing Address - Country:US
Mailing Address - Phone:619-953-7484
Mailing Address - Fax:
Practice Address - Street 1:7855 FAY AVE STE 310
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4280
Practice Address - Country:US
Practice Address - Phone:619-953-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health