Healthcare Provider Details

I. General information

NPI: 1437157179
Provider Name (Legal Business Name): ALEXANDER MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17451 BASTANCHURY RD. SUITE 103A
YORBA LINDA CA
92886-1871
US

IV. Provider business mailing address

17451 BASTANCHURY RD. SUITE 103A
YORBA LINDA CA
92886-1871
US

V. Phone/Fax

Practice location:
  • Phone: 714-961-0143
  • Fax: 714-961-0265
Mailing address:
  • Phone: 714-961-0143
  • Fax: 714-961-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG42379
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG42379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: