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General NPI Number Information
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NPI Number | 1669597167
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Entity Type | Individual
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Provider Name | ERICK RUIZ MIRANDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 335 S MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-3507
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Country | US
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Telephone | 707-293-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 2395 LOMBARD ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94123-2601
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Country | US
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Telephone | 415-796-2242
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A95256
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License Number State | CA
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