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General NPI Number Information
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NPI Number | 1417316365
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Entity Type | Individual
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Provider Name | MIRANDA HOLT C.O.T.A
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Gender | Female
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Dates
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Enumeration Date | 02/21/2016
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Last Update Date | 02/21/2016
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Provider Practice Location Address
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Address Line | 1575 7TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-3704
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Country | US
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Telephone | 877-366-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 PIEDMONT PL
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City | CARROLLTON
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State | TX
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Zip | 75007-5084
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Country | US
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Telephone | 318-537-3975
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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 | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 2444
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License Number State | CA
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