MEDICARE: ELA JEANNE 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	225100000X	Physical Therapist	29212	CA

General Provider Information

NPI Number	:	1699132878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELA JEANNE MIRANDA

Provider Business Mailing Address
First Line	:	30 GOODWIN CIR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 GOODWIN CIR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5141
Country	:	US
Telephone Number	:	916-476-7745
Fax Number	:

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	01/19/2016

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Directions to “ ELA JEANNE MIRANDA ” Practice Location

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