MEDICARE: VICTORIA MIRANDA

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	363A00000X	Physician Assistant	PA18609	TX

General Provider Information

NPI Number	:	1306573100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MIRANDA

Provider Business Mailing Address
First Line	:	1393 GEORGE DIETER DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2726
Country	:	US
Telephone Number	:	713-441-3800
Fax Number	:	713-793-1015

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	02/23/2026

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Directions to “ VICTORIA MIRANDA ” Practice Location

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