Basic Information
| Provider Information | |||||||||
| NPI: | 1609265602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | MARVI | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3768 | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953443768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097257149 | ||||||||
| FaxNumber: | 2097260134 | ||||||||
| Practice Location | |||||||||
| Address1: | 9696 STEPHENS ST | ||||||||
| Address2: | |||||||||
| City: | DELHI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953159550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096670702 | ||||||||
| FaxNumber: | 2096676737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2015 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | A143356 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.