Provider Demographics
NPI:1629119623
Name:MIRANDA, OLIVIA ADELENA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ADELENA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E DESERT HOLLY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2238
Mailing Address - Country:US
Mailing Address - Phone:951-990-7760
Mailing Address - Fax:
Practice Address - Street 1:315 E DESERT HOLLY CIR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2238
Practice Address - Country:US
Practice Address - Phone:951-990-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay