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General NPI Number Information
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NPI Number | 1851911135
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Entity Type | Individual
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Provider Name | MIRIAM ELIZABETH MIRMOTAHARI NP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1133 N PALM CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4431
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Country | US
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Telephone | 760-320-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 25590 PROSPECT AVE APT 30H
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City | LOMA LINDA
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State | CA
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Zip | 92354-3151
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Country | US
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Telephone | 425-443-7677
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95019163
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License Number State | CA
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