Provider Demographics
NPI:1972734457
Name:BRIAN WAYNE MILLER
Entity type:Organization
Organization Name:BRIAN WAYNE MILLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:BA CHEMISTRY
Authorized Official - Phone:951-756-8558
Mailing Address - Street 1:303 INDUSTRIAL WAY
Mailing Address - Street 2:STE 2
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2358
Mailing Address - Country:US
Mailing Address - Phone:951-756-8558
Mailing Address - Fax:
Practice Address - Street 1:303 INDUSTRIAL WAY
Practice Address - Street 2:STE 2
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2358
Practice Address - Country:US
Practice Address - Phone:951-756-8558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-02
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16691332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies