Provider Demographics
NPI:1689830093
Name:MIRANDA, ROSITA L F (MD, M,S, DLO)
Entity Type:Individual
Prefix:DR
First Name:ROSITA
Middle Name:L F
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MD, M,S, DLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:16528 E DESMET CT STE B3100
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3522
Practice Address - Country:US
Practice Address - Phone:509-944-9440
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072603A207Q00000X
WAMD60614801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201169270Medicaid
IN151560050Medicare PIN