Provider Demographics
NPI:1104168236
Name:MILLER, JESSICA A (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2625 ALCATRAZ AVE # 180
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2702
Mailing Address - Country:US
Mailing Address - Phone:510-995-6634
Mailing Address - Fax:510-257-2880
Practice Address - Street 1:3850 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1004
Practice Address - Country:US
Practice Address - Phone:510-225-1025
Practice Address - Fax:510-225-1019
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2023-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA124895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine