MEDICARE: MS. NORMA ASSUNCION MIRANDA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25759	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043221757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORMA ASSUNCION MIRANDA DDS

Provider Business Mailing Address
First Line	:	1729 TERMINO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2121
Country	:	US
Telephone Number	:	562-494-8400
Fax Number	:	562-494-8412

Provider Business Practice Location Address
First Line	:	1729 TERMINO AVE
Second Line	:	1363 S OLIVE ST LOS ANGELES CA 90015
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2121
Country	:	US
Telephone Number	:	562-494-8400
Fax Number	:	562-494-8412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/09/2007

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