Provider Demographics
NPI:1275322208
Name:MILLER, ANGELIQUE
Entity type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 MAGNOLIA AVE STE 103538
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3307
Mailing Address - Country:US
Mailing Address - Phone:323-337-4504
Mailing Address - Fax:
Practice Address - Street 1:56530 29 PALMS HWY UNIT C
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2864
Practice Address - Country:US
Practice Address - Phone:951-464-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals