Provider Demographics
NPI:1679911341
Name:MUCKER, MILTON (CADC II)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:
Last Name:MUCKER
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N TUSTIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3838
Mailing Address - Country:US
Mailing Address - Phone:715-541-4007
Mailing Address - Fax:714-541-2779
Practice Address - Street 1:302 N TUSTIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3838
Practice Address - Country:US
Practice Address - Phone:715-541-4007
Practice Address - Fax:714-541-2779
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator