Provider Demographics
NPI:1730781642
Name:MILLER, MAYUMI REINA
Entity type:Individual
Prefix:
First Name:MAYUMI
Middle Name:REINA
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 1:2910 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4333
Mailing Address - Country:US
Mailing Address - Phone:917-750-3784
Mailing Address - Fax:
Practice Address - Street 1:2910 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4333
Practice Address - Country:US
Practice Address - Phone:917-750-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife