Provider Demographics
NPI:1689177297
Name:MIRANDA, RACHEL ANNE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
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 1:3500 SNYDER AVE APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3991
Mailing Address - Country:US
Mailing Address - Phone:714-249-8904
Mailing Address - Fax:
Practice Address - Street 1:3500 SNYDER AVE APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3991
Practice Address - Country:US
Practice Address - Phone:714-249-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer