Provider Demographics
NPI:1932826369
Name:PARTON, MIRANDA BETH (BA, MA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:BETH
Last Name:PARTON
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:PARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6300
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:CA
Mailing Address - Zip Code:92325-6300
Mailing Address - Country:US
Mailing Address - Phone:909-273-7714
Mailing Address - Fax:
Practice Address - Street 1:340 HWY 138
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325
Practice Address - Country:US
Practice Address - Phone:909-273-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist