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General NPI Number Information
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NPI Number | 1134692692
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Entity Type | Individual
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Provider Name | MONIQUE MIRANDA HERNANDEZ PA
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 25405 HANCOCK AVE STE 108
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City | MURRIETA
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State | CA
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Zip | 92562-5983
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Country | US
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Telephone | 951-304-7854
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Fax | 951-304-7855
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Provider Business Mailing Address
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Address Line | 39702 COLUMBIA UNION DR UNIT A
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City | MURRIETA
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State | CA
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Zip | 92563-8315
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Country | US
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Telephone | 661-733-4198
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA56370
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License Number State | CA
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