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General NPI Number Information
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NPI Number | 1013448588
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Entity Type | Individual
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Provider Name | MIRA MARIA JOHN MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 9300 CAMPUS POINT DR
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City | LA JOLLA
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State | CA
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Zip | 92037-1300
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Country | US
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Telephone | 800-926-8273
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 57326
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City | LOS ANGELES
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State | CA
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Zip | 90074-7326
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Country | US
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Telephone | 800-926-8273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A196769
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD61153632
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD61153632
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A196769
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 298729
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A196769
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License Number State | CA
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