Provider Demographics
NPI:1770190480
Name:MIRAMINDS MEDICAL AID
Entity Type:Organization
Organization Name:MIRAMINDS MEDICAL AID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:YUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, ACNP
Authorized Official - Phone:424-372-7860
Mailing Address - Street 1:15909 S ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4545
Mailing Address - Country:US
Mailing Address - Phone:310-770-2057
Mailing Address - Fax:575-205-0309
Practice Address - Street 1:9615 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3527
Practice Address - Country:US
Practice Address - Phone:310-770-2057
Practice Address - Fax:575-205-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251J00000XAgenciesNursing Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health