Healthcare Provider Details

I. General information

NPI: 1730757634
Provider Name (Legal Business Name): JAILON MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 LEIGHANN LANE DR
HOUSTON TX
77047-6735
US

IV. Provider business mailing address

4115 LEIGHANN LANE DR
HOUSTON TX
77047-6735
US

V. Phone/Fax

Practice location:
  • Phone: 832-728-9133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: