Provider Demographics
NPI:1770666802
Name:MIRANDA, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
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 1:7324 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2012
Mailing Address - Country:US
Mailing Address - Phone:713-484-5105
Mailing Address - Fax:713-988-9550
Practice Address - Street 1:7324 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2012
Practice Address - Country:US
Practice Address - Phone:713-484-5105
Practice Address - Fax:713-988-9550
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515412163W00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J0422Medicare PIN