Healthcare Provider Details

I. General information

NPI: 1477280550
Provider Name (Legal Business Name): MICHAEL J MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JULES MILLER

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6939 SUNRISE BLVD STE 107
CITRUS HEIGHTS CA
95610-3153
US

IV. Provider business mailing address

5850 GRANITE PKWY STE 600
PLANO TX
75024-6753
US

V. Phone/Fax

Practice location:
  • Phone: 916-547-5908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: