Healthcare Provider Details

I. General information

NPI: 1326129917
Provider Name (Legal Business Name): YOMAIRA MIRANDA-LEON NUTRITIONIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

IV. Provider business mailing address

6329 DRY FORK LN
RALEIGH NC
27617-7655
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4585
  • Fax: 919-956-4558
Mailing address:
  • Phone: 919-412-8479
  • Fax: 919-341-7276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: