MEDICARE: GEORGE G MIRANDA, MD, INC

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	207RH0003X	Hematology & Oncology Physician	A106771	CA

General Provider Information

NPI Number	:	1861750895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE G MIRANDA, MD, INC

Provider Business Mailing Address
First Line	:	26691 PLAZA
Second Line	:	STE 200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8582
Country	:	US
Telephone Number	:	949-347-0600
Fax Number	:	949-347-0746

Provider Business Practice Location Address
First Line	:	26691 PLAZA
Second Line	:	STE 200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8582
Country	:	US
Telephone Number	:	949-347-0600
Fax Number	:	949-347-0746

Authorized Official
Title or Position	:	CEO
Name	:	DR. GEORGE GUINTO MIRANDA
Credential	:	MD
Telephone Number	:	949-347-0600

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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