MEDICARE: MARTHA MIRANDA

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	374U00000X	Home Health Aide	00250026	CA
2	376K00000X	Nurse's Aide	00826074	CA

General Provider Information

NPI Number	:	1417619131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA MIRANDA

Provider Business Mailing Address
First Line	:	4350 HILLVIEW DR
Second Line	:
City	:	PITTSBURG
State	:	CA
Zip	:	94565-6026
Country	:	US
Telephone Number	:	510-712-8561
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 CUTTING BLVD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-2662
Country	:	US
Telephone Number	:	510-233-8513
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	10/11/2021

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Directions to “ MARTHA MIRANDA ” Practice Location

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