Provider Demographics
NPI:1548487408
Name:MIRANDA, FREDERICK RALPH (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:RALPH
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E ROMIE LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4026
Mailing Address - Country:US
Mailing Address - Phone:831-769-0163
Mailing Address - Fax:831-769-0165
Practice Address - Street 1:535 E ROMIE LN
Practice Address - Street 2:SUITE 5
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4026
Practice Address - Country:US
Practice Address - Phone:831-769-0163
Practice Address - Fax:831-769-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A303700Medicare ID - Type Unspecified