Healthcare Provider Details

I. General information

NPI: 1609733112
Provider Name (Legal Business Name): KATHRYN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29995 TECHNOLOGY DR STE 102
MURRIETA CA
92563-2633
US

IV. Provider business mailing address

40997 CEBU DR
TEMECULA CA
92591-2132
US

V. Phone/Fax

Practice location:
  • Phone: 951-904-0884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: