Provider Demographics
NPI:1861411381
Name:MILLER, BRIAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511522
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-8077
Mailing Address - Country:US
Mailing Address - Phone:858-939-4393
Mailing Address - Fax:619-740-5055
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:DEPT OF BEHAV HEALTH
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:858-939-4393
Practice Address - Fax:619-740-5055
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA681802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-2376471OtherEIN
CAG91585Medicare UPIN