Provider Demographics
NPI:1023438488
Name:TIMOTHY ROBERT MILLER, M.D., INC.
Entity type:Organization
Organization Name:TIMOTHY ROBERT MILLER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-973-5175
Mailing Address - Street 1:2 JOURNEY
Mailing Address - Street 2:STE 208
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3332
Mailing Address - Country:US
Mailing Address - Phone:949-973-5175
Mailing Address - Fax:949-215-5428
Practice Address - Street 1:2 JOURNEY
Practice Address - Street 2:STE 208
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3332
Practice Address - Country:US
Practice Address - Phone:949-973-5175
Practice Address - Fax:949-215-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty