Healthcare Provider Details

I. General information

NPI: 1417808734
Provider Name (Legal Business Name): ANDREW J MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 JUAN TABO BLVD NE STE U
ALBUQUERQUE NM
87112-4459
US

IV. Provider business mailing address

6100 HARPER DR NE APT 3
ALBUQUERQUE NM
87109-3576
US

V. Phone/Fax

Practice location:
  • Phone: 505-719-0170
  • Fax:
Mailing address:
  • Phone: 505-810-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: