1770504664 NPI number — SHEILA L MIRANDA MD PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770504664 NPI number — SHEILA L MIRANDA MD PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEILA L MIRANDA MD PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770504664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9811 W CHARLESTON BLVD
Provider Second Line Business Mailing Address:
SUITE 2543
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89117-7528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-256-3637
Provider Business Mailing Address Fax Number:
702-256-3307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9811 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
2543
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-7528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-949-0885
Provider Business Practice Location Address Fax Number:
702-951-7579
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-949-0885

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  11089 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1770504664 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1770504664 . This is a "NPI GROUP" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 100504137 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com