Provider Demographics
NPI:1679616437
Name:MIRANDA, JOSE PARAS (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:PARAS
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:P
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:11795 EDUCATION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2454
Practice Address - Country:US
Practice Address - Phone:530-889-7439
Practice Address - Fax:530-889-7435
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47853207R00000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478530Medicaid
CA00A478531Medicare ID - Type Unspecified
CABA679Medicare PIN
CA00A478530Medicaid