Provider Demographics
NPI:1477887628
Name:METCALF, MIRNA (OMSA)
Entity Type:Individual
Prefix:MRS
First Name:MIRNA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:OMSA
Other - Prefix:MS
Other - First Name:MIRNA
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OMSA
Mailing Address - Street 1:1316 COFFEE RD
Mailing Address - Street 2:BLDG E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3191
Mailing Address - Country:US
Mailing Address - Phone:209-522-9963
Mailing Address - Fax:209-522-5184
Practice Address - Street 1:1316 COFFEE RD
Practice Address - Street 2:BLDG E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3191
Practice Address - Country:US
Practice Address - Phone:209-522-9963
Practice Address - Fax:209-522-5184
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant