Individual
DR. GARY MICHAEL MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
523 HAYES LN, PETALUMA, CA 94952-4011
(800) 257-8715
(800) 819-1655
Mailing address
43409 BREWSTER CT, TEMECULA, CA 92592-4315
(951) 303-2166
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY15695
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PL156950
BLUE CROSS BLUE SHIELD
CA
01
—
PSY156950
RIVERSIDE COUNTY
CA
05
—
PSY156950
—
CA
Enumeration date
07/20/2006
Last updated
07/08/2007
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