Healthcare Provider Details

I. General information

NPI: 1730920141
Provider Name (Legal Business Name): MIRANDAHEALTH MEDICAL CENTER INC A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/03/2024
Certification Date: 06/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 SEPHOS ST
MANTECA CA
95337-8079
US

IV. Provider business mailing address

1222 SEPHOS ST
MANTECA CA
95337-8079
US

V. Phone/Fax

Practice location:
  • Phone: 209-456-4323
  • Fax:
Mailing address:
  • Phone: 209-456-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYDEL MIRANDA
Title or Position: CEO
Credential: ARNP-BC
Phone: 209-456-4323