Provider Demographics
NPI:1770600249
Name:MILLER, LEE ROBERT (AA)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ROBERT
Last Name:MILLER
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 S VERMONT AVE
Mailing Address - Street 2:B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2909
Mailing Address - Country:US
Mailing Address - Phone:323-527-1198
Mailing Address - Fax:
Practice Address - Street 1:5201 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3527
Practice Address - Country:US
Practice Address - Phone:323-751-2677
Practice Address - Fax:323-751-0917
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner