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NPI Code Detail

MEDICARE: MRS. YOMAIRA MIRANDA-LEON NUTRITIONIST

MEDICARE: MRS. YOMAIRA MIRANDA-LEON NUTRITIONIST
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
1133N00000XNutritionist

General Provider Information

NPI Number : 1326129917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. YOMAIRA MIRANDA-LEON NUTRITIONIST
Provider Business Mailing Address
First Line : 6329 DRY FORK LN
Second Line :
City : RALEIGH
State : NC
Zip : 27617-7655
Country : US
Telephone Number : 919-412-8479
Fax Number : 919-341-7276
Provider Business Practice Location Address
First Line : 1301 FAYETTEVILLE ST
Second Line :
City : DURHAM
State : NC
Zip : 27707-2325
Country : US
Telephone Number : 919-956-4585
Fax Number : 919-956-4558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. YOMAIRA MIRANDA-LEON NUTRITIONIST” Practice Location

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