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General NPI Number Information
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NPI Number | 1679382048
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Entity Type | Individual
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Provider Name | DIEGO MIRANDA
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Gender | Male
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 679 S NEW HAMPSHIRE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-1355
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Country | US
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Telephone | 213-639-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 11131 CAMARILLO ST APT 4
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-1224
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Country | US
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Telephone | 818-644-9659
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 277881
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License Number State | CA
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