MEDICARE: DR. GABRIEL 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	207Q00000X	Family Medicine Physician	A038721	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A038721	OTHER	CA	OTHER PRIVATE INS.PROV.NO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A0387210	OTHER	CA	BLUE SHIELD PROVIDER NUM.

General Provider Information

NPI Number	:	1952377756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL MIRANDA M.D.

Provider Business Mailing Address
First Line	:	34167 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-2230
Country	:	US
Telephone Number	:	510-790-6315
Fax Number	:

Provider Business Practice Location Address
First Line	:	34167 FREMONT BLVD
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-2230
Country	:	US
Telephone Number	:	510-790-6315
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/29/2010

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