Shawn Lauritz Miller Sr., OWNER

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

560051AP Issued in CA

Practice address

3069 Cisco CT
Simi Valley, CA 93063-1809

Phone

(805) 624-7700

NPI assigned

Sep 18, 2016

Last updated

Sep 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474156800000",
    "number": "1992253009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3069 CISCO CT",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930631809",
            "telephone_number": "805-624-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3069 CISCO CT",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930631809",
            "telephone_number": "805-624-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "SHAWN",
        "middle_name": "LAURITZ",
        "name_suffix": "Sr.",
        "credential": "OWNER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-18",
        "last_updated": "2016-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "560051AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Alexander Mirras
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• Substance Abuse Rehabilitation Facility in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.