MEDICARE: MARCELLUS MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1932063948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELLUS MILLER

Provider Business Mailing Address
First Line	:	1756 W AVENUE J12 APT 103C
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-4654
Country	:	US
Telephone Number	:	661-470-9721
Fax Number	:	661-470-9721

Provider Business Practice Location Address
First Line	:	14724 VENTURA BLVD STE 1105
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3510
Country	:	US
Telephone Number	:	747-298-3463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “ MARCELLUS MILLER ” Practice Location

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