1225327331 NPI number — MRS. LISA HEIDT MILLER LCSW

Table of content: MRS. LISA HEIDT MILLER LCSW (NPI 1225327331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225327331 NPI number — MRS. LISA HEIDT MILLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
LISA
Provider Middle Name:
HEIDT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225327331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10992 SAN DIEGO MISSION RD
Provider Second Line Business Mailing Address:
KAISER HOSPICE THIRD FLOOR
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108-2444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-641-4483
Provider Business Mailing Address Fax Number:
619-641-4111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10992 SAN DIEGO MISSION RD
Provider Second Line Business Practice Location Address:
KAISER HOSPICE THIRD FLOOR
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-641-4483
Provider Business Practice Location Address Fax Number:
619-641-4111
Provider Enumeration Date:
03/30/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  23787 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)