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NPI Code Detail

MEDICARE: DR. RAYDEL MIRANDA ARNP-BC

MEDICARE: DR. RAYDEL MIRANDA ARNP-BC
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
1363LF0000XFamily Nurse PractitionerAPRN11006526FL
2363LF0000XFamily Nurse PractitionerNP95022834CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APRN11006526OTHERFLBOARD OF NURSING

General Provider Information

NPI Number : 1770856890
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAYDEL MIRANDA ARNP-BC
Provider Business Mailing Address
First Line : 737 W CHILDS AVE
Second Line :
City : MERCED
State : CA
Zip : 95341-6805
Country : US
Telephone Number : 209-722-4842
Fax Number : 209-359-2045
Provider Business Practice Location Address
First Line : 2240 W MONTE VISTA AVE
Second Line :
City : TURLOCK
State : CA
Zip : 95382-9667
Country : US
Telephone Number : 209-722-4842
Fax Number : 209-667-1269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2012
Last Update Date : 04/26/2024

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