Provider Demographics
NPI:1326129917
Name:MIRANDA-LEON, YOMAIRA (NUTRITIONIST)
Entity Type:Individual
Prefix:MRS
First Name:YOMAIRA
Middle Name:
Last Name:MIRANDA-LEON
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 DRY FORK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7655
Mailing Address - Country:US
Mailing Address - Phone:919-412-8479
Mailing Address - Fax:919-341-7276
Practice Address - Street 1:1301 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2325
Practice Address - Country:US
Practice Address - Phone:919-956-4585
Practice Address - Fax:919-956-4558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist