Healthcare Provider Details

I. General information

NPI: 1871388207
Provider Name (Legal Business Name): JOHNATHON STEVEN MIRANDA III EMT-B, 68W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8429 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-0626
US

IV. Provider business mailing address

8429 WHITE OAK AVE
RANCHO CUCAMONGA CA
91730-0626
US

V. Phone/Fax

Practice location:
  • Phone: 909-316-9296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: