Provider Demographics
NPI:1407895006
Name:MIRANDA, RAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:272 VICTORIA ST
Mailing Address - Street 2:STE. 2K
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1974
Mailing Address - Country:US
Mailing Address - Phone:949-646-1631
Mailing Address - Fax:949-548-7475
Practice Address - Street 1:272 VICTORIA ST
Practice Address - Street 2:STE. 2K
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1974
Practice Address - Country:US
Practice Address - Phone:949-646-1631
Practice Address - Fax:949-548-7475
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA049913207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine