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General NPI Number Information
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NPI Number | 1477560779
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Entity Type | Individual
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Provider Name | YVONNE MIRANDA M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 3207 ROGERS RD # 107
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4826
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Country | US
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Telephone | 210-680-7334
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Fax | 210-545-7041
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Provider Business Mailing Address
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Address Line | 131 CANDELARIA
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City | HELOTES
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State | TX
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Zip | 78023-4711
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Country | US
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Telephone | 210-392-3292
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Fax | 210-543-9680
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K8953
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License Number State | TX
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