1366655235 NPI number — DR. NOEL SANTOS MIRANDA DMD

Table of content: DR. NOEL SANTOS MIRANDA DMD (NPI 1366655235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366655235 NPI number — DR. NOEL SANTOS MIRANDA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIRANDA
Provider First Name:
NOEL
Provider Middle Name:
SANTOS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

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:
1366655235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1486 HUNTINGTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
SO SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94080-5971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-583-8822
Provider Business Mailing Address Fax Number:
650-583-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1486 HUNTINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SO SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94080-5971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-583-8822
Provider Business Practice Location Address Fax Number:
650-583-7940
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  41283 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 520109 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B4128304 . This is a "DELTA OF CA STATE GOVERNM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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