MEDICARE: MIANDA CHEREE CARR MD

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	207V00000X	Obstetrics & Gynecology Physician	A104660	CA

General Provider Information

NPI Number	:	1083815823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIANDA CHEREE CARR MD

Provider Business Mailing Address
First Line	:	4004 BEYER BLVD
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2007
Country	:	US
Telephone Number	:	619-662-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 E 8TH ST
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2956
Country	:	US
Telephone Number	:	619-662-4118
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/15/2011

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