Basic Information
| Provider Information | |||||||||
| NPI: | 1033179254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28780 SINGLE OAK DR | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925903625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516764193 | ||||||||
| FaxNumber: | 9517191469 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 E ELDER ST STE 105 | ||||||||
| Address2: | |||||||||
| City: | FALLBROOK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920283082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607288344 | ||||||||
| FaxNumber: | 7607286198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 434 | NE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A11653 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.