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NPI Code Detail

MEDICARE: MR. JOSE FREDERICKO MILLER JR. SUDRC

MEDICARE: MR. JOSE FREDERICKO MILLER JR. SUDRC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor24801CA

General Provider Information

NPI Number : 1104769512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSE FREDERICKO MILLER JR. SUDRC
Provider Business Mailing Address
First Line : 44 S MENTOR AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-2902
Country : US
Telephone Number : 626-795-9127
Fax Number :
Provider Business Practice Location Address
First Line : 44 S MENTOR AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-2902
Country : US
Telephone Number : 626-795-9127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2026
Last Update Date : 04/10/2026

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