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General NPI Number Information
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NPI Number | 1497023865
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Entity Type | Individual
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Provider Name | MIRANDA SALIB ISOM
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Gender | Female
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 4550 E BELL ROAD SUITE 172
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City | PHOENIX
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State | AZ
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Zip | 85032
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Country | US
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Telephone | 480-443-8400
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Fax | 480-443-8697
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Provider Business Mailing Address
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Address Line | 4550 E BELL RD SUITE 172
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City | PHOENIX
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State | AZ
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Zip | 85032-9306
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Country | US
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Telephone | 480-443-8400
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Fax | 480-443-8697
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5110
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License Number State | AZ
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