Provider Demographics
NPI:1164073755
Name:RIFENBURGH, MIRANDA WINIFRED (MSN, AGPCNP-BC, CWS)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:WINIFRED
Last Name:RIFENBURGH
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 E LANAI ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3814
Mailing Address - Country:US
Mailing Address - Phone:818-318-2530
Mailing Address - Fax:
Practice Address - Street 1:222 N PACIFIC COAST HWY STE 1420
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5648
Practice Address - Country:US
Practice Address - Phone:818-318-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012259363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care