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General NPI Number Information
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NPI Number | 1922371509
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Entity Type | Organization
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Legal Business Name | ROSALINDA MIRANDA-MAURICIO DDS A DENTAL CORP
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 2531 HOWARD RD SUITE 103
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City | MADERA
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State | CA
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Zip | 93637-5040
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Country | US
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Telephone | 559-674-0927
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Fax | 559-674-0595
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Provider Business Mailing Address
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Address Line | 2531 HOWARD RD SUITE 103
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City | MADERA
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State | CA
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Zip | 93637-5040
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Country | US
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Telephone | 559-674-0927
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Fax | 559-674-0595
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSALINDA MIRANDA MAURICIO
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Credential | DDS
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Telephone | 559-674-0927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46112
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License Number State | CA
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