Provider Demographics
NPI:1538874946
Name:MIRANDA-JARAM, DOMINIC ALEXANDER
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:ALEXANDER
Last Name:MIRANDA-JARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 CHESAPEAKE CT
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4514
Mailing Address - Country:US
Mailing Address - Phone:440-610-6208
Mailing Address - Fax:
Practice Address - Street 1:149 CHESAPEAKE CT
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4514
Practice Address - Country:US
Practice Address - Phone:440-610-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care