Provider Demographics
NPI:1437157179
Name:MILLER, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17451 BASTANCHURY RD. SUITE 103A
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1871
Mailing Address - Country:US
Mailing Address - Phone:714-961-0143
Mailing Address - Fax:714-961-0265
Practice Address - Street 1:17451 BASTANCHURY RD. SUITE 103A
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1871
Practice Address - Country:US
Practice Address - Phone:714-961-0143
Practice Address - Fax:714-961-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42379207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3162518Medicaid
CAG42379Medicare ID - Type Unspecified
CA3162518Medicaid