Provider Demographics
NPI:1730696626
Name:MILLER, CAMILLA MAE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:CAMILLA
Middle Name:MAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 MARINERS WAY
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1099 MARINERS WAY
Practice Address - Street 2:
Practice Address - City:PEBBLE BEACH
Practice Address - State:CA
Practice Address - Zip Code:93953-3113
Practice Address - Country:US
Practice Address - Phone:805-540-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-130072174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN