Healthcare Provider Details

I. General information

NPI: 1033179254
Provider Name (Legal Business Name): BRANDON WAYNE MILLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST STE 105
FALLBROOK CA
92028-3082
US

IV. Provider business mailing address

28780 SINGLE OAK DR SUITE 160
TEMECULA CA
92590-3625
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-8344
  • Fax: 760-728-6198
Mailing address:
  • Phone: 951-676-4193
  • Fax: 951-719-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number434
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: