Provider Demographics
NPI:1467481697
Name:MIRANDA, RHODA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:MARIE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 E COLLEGE ST
Mailing Address - Street 2:PMB #111
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2105
Mailing Address - Country:US
Mailing Address - Phone:626-967-0905
Mailing Address - Fax:
Practice Address - Street 1:173 E COLLEGE ST
Practice Address - Street 2:PMB #111
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2105
Practice Address - Country:US
Practice Address - Phone:626-967-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN209503164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse