Healthcare Provider Details

I. General information

NPI: 1164939161
Provider Name (Legal Business Name): AARON MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD STE 2500
SACRAMENTO CA
95816-5267
US

IV. Provider business mailing address

7248 S LAND PARK DR STE 205
SACRAMENTO CA
95831-3661
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number65006164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95108216
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95006164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: