Candy Miller | NPI 1922489681

Key facts

NPI: 1922489681
Entity type: Individual (NPI type 1)
Primary specialty: Addiction (Substance Use Disorder) Counselor 101YA0400X
License: C17031214 (CA)
Practice address: 10936 Dale Ave
Stanton, CA 90680-2724
Phone: (714) 952-4032
NPI assigned: Jun 17, 2015
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Roque Center, Inc Substance Abuse Rehabilitation Facility · Stanton, CA · NPI 1689772170

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
C17031214	CA	MD	Addiction (Substance Use Disorder) Counselor

Practice roles

Organization	Specialty	Status	New patients
Roque Center, Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction (Substance Use Disorder) Counselor	101YA0400X	C17031214	CA	Yes

Addresses

Primary practice location

10936 Dale Ave
Stanton, CA 90680-2724

Mailing address

10936 Dale Ave
Stanton, CA 90680-2724
Phone (714) 952-4032

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2015.

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434499200000",
    "number": "1922489681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10936 DALE AVE",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906802724",
            "telephone_number": "714-952-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10936 DALE AVE",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "906802724",
            "telephone_number": "714-952-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CANDY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2015-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "C17031214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanton, CA

All providers in Stanton, CA · Addiction (Substance Use Disorder) Counselor in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.