MEDICARE: DEE JAY NERY MIRANDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	40990	TN
2	208000000X	Pediatrics Physician	A101360	CA

General Provider Information

NPI Number	:	1295764926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEE JAY NERY MIRANDA MD

Provider Business Mailing Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2155 IRON POINT RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-8707
Country	:	US
Telephone Number	:	916-817-5463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	12/13/2021

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