Provider Demographics
NPI:1649573098
Name:MILLER, RANDY DEAN (CERT PERFUSIONIST)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:CERT PERFUSIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1004
Mailing Address - Country:US
Mailing Address - Phone:714-269-4066
Mailing Address - Fax:909-591-8343
Practice Address - Street 1:1981 SCENIC RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1004
Practice Address - Country:US
Practice Address - Phone:714-269-4066
Practice Address - Fax:909-591-8343
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist