Provider Demographics
NPI:1205879822
Name:MIRANDA, FERNANDO E SR (MD , P A ,)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:E
Last Name:MIRANDA
Suffix:SR
Gender:M
Credentials:MD , P A ,
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 205732
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-5732
Mailing Address - Country:US
Mailing Address - Phone:713-960-0590
Mailing Address - Fax:
Practice Address - Street 1:4301B VISTA RD
Practice Address - Street 2:#100
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2117
Practice Address - Country:US
Practice Address - Phone:713-960-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery