MEDICARE: EVELYN MIRANDA ARCOS

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1447092754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN MIRANDA ARCOS

Provider Business Mailing Address
First Line	:	157 VIRGINIA AVE # 2119
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLVD LAZARO CARDENAS 5201
Second Line	:
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22160
Country	:	MX
Telephone Number	:	619-844-3203
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EVELYN MIRANDA ARCOS
Credential	:	DDS
Telephone Number	:	619-272-9021

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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