MEDICARE: MIRANDA CURTIS RD

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	133VN1004X	Pediatric Nutrition Registered Dietitian
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1942071386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA CURTIS RD

Provider Business Mailing Address
First Line	:	1310 S WAYFARER
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 TELLURIDE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7769
Country	:	US
Telephone Number	:	480-464-1959
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	02/27/2024

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Directions to “ MIRANDA CURTIS RD” Practice Location

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