Provider Demographics
NPI:1417067380
Name:ADURA MIRANDA, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:ADURA MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14721 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5511
Mailing Address - Country:US
Mailing Address - Phone:408-923-0257
Mailing Address - Fax:408-741-1683
Practice Address - Street 1:244 N JACKSON AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1604
Practice Address - Country:US
Practice Address - Phone:408-923-0257
Practice Address - Fax:408-741-1683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7699318Medicaid
CA00G378180Medicare ID - Type Unspecified
CA7699318Medicaid