Provider Demographics
NPI:1194176081
Name:TODD C MILLER, MD, INC
Entity type:Organization
Organization Name:TODD C MILLER, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-215-9463
Mailing Address - Street 1:3851 KATELLA AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3567
Mailing Address - Country:US
Mailing Address - Phone:562-596-2925
Mailing Address - Fax:562-596-5703
Practice Address - Street 1:3851 KATELLA AVE STE 320
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3567
Practice Address - Country:US
Practice Address - Phone:562-596-2925
Practice Address - Fax:562-596-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90116OtherMEDICAL LICENSE