Healthcare Provider Details

I. General information

NPI: 1790628287
Provider Name (Legal Business Name): DIANA LIZBETH MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W BROADWAY ST
HOBBS NM
88240-5529
US

IV. Provider business mailing address

11404 CAT CLAW
HOBBS NM
88242-0782
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-3168
  • Fax:
Mailing address:
  • Phone: 575-263-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: