Healthcare Provider Details

I. General information

NPI: 1154740454
Provider Name (Legal Business Name): RENEE MAY SAYSON MIRANDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 BRIMHALL RD
BAKERSFIELD CA
93312-2779
US

IV. Provider business mailing address

9710 BRIMHALL RD
BAKERSFIELD CA
93312-2779
US

V. Phone/Fax

Practice location:
  • Phone: 661-829-6747
  • Fax: 661-829-6937
Mailing address:
  • Phone: 661-829-6747
  • Fax: 661-829-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101261914
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35130444
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58998
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: