Healthcare Provider Details

I. General information

NPI: 1134532732
Provider Name (Legal Business Name): JOE MICHAEL MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

IV. Provider business mailing address

100 N BARRANCA ST STE 130
WEST COVINA CA
91791-1637
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax: 626-433-1313
Mailing address:
  • Phone: 626-433-1311
  • Fax: 626-433-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: