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General NPI Number Information
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NPI Number | 1841752599
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Entity Type | Individual
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Provider Name | ANTHONY MIRANDA RECIDORO DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 200 MERCY CIRCLE
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City | CAMP PENDLETON
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State | CA
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Zip | 92055
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Country | US
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Telephone | 760-725-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 631 MEADOWOOD ST
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City | FALLBROOK
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State | CA
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Zip | 92028-3829
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Country | US
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Telephone | 951-764-9768
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102206230
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License Number State | VA
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