Healthcare Provider Details

I. General information

NPI: 1629119623
Provider Name (Legal Business Name): OLIVIA ADELENA MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E DESERT HOLLY CIR
PALM SPRINGS CA
92262-2238
US

IV. Provider business mailing address

315 E DESERT HOLLY CIR
PALM SPRINGS CA
92262-2238
US

V. Phone/Fax

Practice location:
  • Phone: 951-990-7760
  • Fax:
Mailing address:
  • Phone: 951-990-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: