Healthcare Provider Details

I. General information

NPI: 1295089571
Provider Name (Legal Business Name): BRIAN P. MILLER, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR DEPT OF BEHAV HEALTH
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 511522
LOS ANGELES CA
90051-8077
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA68180
License Number StateCA

VIII. Authorized Official

Name: BRIAN MILLER
Title or Position: OWNER
Credential: M.D.
Phone: 858-442-2434