MEDICARE: ERICK RUIZ MIRANDA M.D.

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	207P00000X	Emergency Medicine Physician	A95256	CA

General Provider Information

NPI Number	:	1669597167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICK RUIZ MIRANDA M.D.

Provider Business Mailing Address
First Line	:	2395 LOMBARD ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2601
Country	:	US
Telephone Number	:	415-796-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 S MCDOWELL BLVD
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94954-3507
Country	:	US
Telephone Number	:	707-293-1110
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/02/2025

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