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General NPI Number Information
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NPI Number | 1972734457
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Entity Type | Organization
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Legal Business Name | BRIAN WAYNE MILLER
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Dates
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Enumeration Date | 08/02/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 303 INDUSTRIAL WAY STE 2
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City | FALLBROOK
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State | CA
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Zip | 92028-2358
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Country | US
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Telephone | 951-756-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 303 INDUSTRIAL WAY STE 2
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City | FALLBROOK
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State | CA
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Zip | 92028-2358
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Country | US
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Telephone | 951-756-8558
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN WAYNE MILLER
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Credential | B.A. CHEMISTRY
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Telephone | 951-756-8558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 16691
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License Number State | CA
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