# SPA M MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578790713
- **Authorized official:** DR. DENNNIS K. MILLER D.O. (CEO)
- **Authorized official phone:** (714) 465-7125

## Contact information

- **Practice address:** 32034 BLAZING STAR ST, WINCHESTER, CA 92596-8941
- **Practice address phone:** (951) 325-8307
- **Mailing address:** 32034 BLAZING STAR ST, WINCHESTER, CA 92596-8941
- **Mailing address phone:** (951) 325-8307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 20A8981 | CA | Yes |

## Other

- **Enumeration date:** 06/15/2009
- **Last updated:** 06/15/2009