Provider Demographics
NPI:1639147838
Name:MIRANDA, VALERIE (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
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 1:4600 S MILL AVE
Mailing Address - Street 2:STE 280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-6850
Mailing Address - Country:US
Mailing Address - Phone:602-216-6862
Mailing Address - Fax:602-216-9745
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:SUITE # 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2830
Practice Address - Country:US
Practice Address - Phone:602-216-6862
Practice Address - Fax:602-216-9745
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36614207Q00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204996OtherAHCCCS ID
AZFM2341941OtherDEA
AZ204996OtherAHCCCS ID