Healthcare Provider Details

I. General information

NPI: 1770856890
Provider Name (Legal Business Name): RAYDEL MIRANDA ARNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 W MONTE VISTA AVE
TURLOCK CA
95382-9667
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax: 209-667-1269
Mailing address:
  • Phone: 209-722-4842
  • Fax: 209-359-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006526
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95022834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: