Provider Demographics
NPI:1053931758
Name:MILLER, KRISTIINA CAROL (MD)
Entity type:Individual
Prefix:MS
First Name:KRISTIINA
Middle Name:CAROL
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11370 ANDERSON ST STE 3900
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3450
Mailing Address - Country:US
Mailing Address - Phone:909-558-2806
Mailing Address - Fax:
Practice Address - Street 1:11370 ANDERSON ST STE 3900
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3450
Practice Address - Country:US
Practice Address - Phone:909-558-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2024-12-04
Deactivation Date:2022-01-10
Deactivation Code:
Reactivation Date:2023-04-18
Provider Licenses
StateLicense IDTaxonomies
CAA181621207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology