Provider Demographics
NPI:1477560779
Name:MIRANDA, YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CANDELARIA
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4711
Mailing Address - Country:US
Mailing Address - Phone:210-392-3292
Mailing Address - Fax:210-543-9680
Practice Address - Street 1:3207 ROGERS RD # 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4826
Practice Address - Country:US
Practice Address - Phone:210-680-7334
Practice Address - Fax:210-545-7041
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140974001Medicaid
TXH0116513OtherDPS
TX83187KMedicare ID - Type Unspecified
TXBM6902034OtherDEA