Individual
JORDAN DALE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10833 LE CONTE AVE, LOS ANGELES, CA 90095-3075
(310) 825-9111
Mailing address
FILE 4501, LOS ANGELES, CA 90074-0001
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G24744
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G247440
BLUE SHIELD OF CA
CA
05
—
00G247440
—
CA
01
—
00G247440303
CALOPTIMA
CA
Enumeration date
06/22/2006
Last updated
07/08/2007
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