Healthcare Provider Details

I. General information

NPI: 1154839579
Provider Name (Legal Business Name): JOSE MIRANDA ANAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 TX-151
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

2507 OAK RAIN
SAN ANTONIO TX
78251-2527
US

V. Phone/Fax

Practice location:
  • Phone: 210-703-8141
  • Fax:
Mailing address:
  • Phone: 619-818-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRCP000078099
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: