Provider Demographics
NPI:1922594530
Name:CADENA MIRANDA, CLAIR (DPM)
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:
Last Name:CADENA MIRANDA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CLAIR
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2930 HILLRISE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4776
Mailing Address - Country:US
Mailing Address - Phone:575-522-3330
Mailing Address - Fax:
Practice Address - Street 1:2930 HILLRISE DR STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4776
Practice Address - Country:US
Practice Address - Phone:575-522-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPOD449213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery