Healthcare Provider Details

I. General information

NPI: 1174586317
Provider Name (Legal Business Name): JOHN J MILLER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 FRANCISCAN CT
LADERA RANCH CA
92694-1538
US

IV. Provider business mailing address

2 FRANCISCAN CT
LADERA RANCH CA
92694-1538
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-3340
  • Fax: 949-861-4885
Mailing address:
  • Phone: 949-274-3340
  • Fax: 949-861-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG26813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: