MEDICARE: MS. BIANCA ESTHER MIRA

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	172V00000X	Community Health Worker		CA
2	373H00000X	Day Training/Habilitation Specialist

General Provider Information

NPI Number	:	1285087668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BIANCA ESTHER MIRA

Provider Business Mailing Address
First Line	:	700 AIRPORT BLVD STE 490&495
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1908
Country	:	US
Telephone Number	:	650-517-8210
Fax Number	:	650-620-9549

Provider Business Practice Location Address
First Line	:	700 AIRPORT BLVD STE 490&495
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1908
Country	:	US
Telephone Number	:	650-517-8210
Fax Number	:	650-620-9549

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	08/27/2025

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