Provider Demographics
NPI:1730920141
Name:MIRANDAHEALTH MEDICAL CENTER INC A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:MIRANDAHEALTH MEDICAL CENTER INC A PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-BC
Authorized Official - Phone:209-456-4323
Mailing Address - Street 1:1222 SEPHOS ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8079
Mailing Address - Country:US
Mailing Address - Phone:209-456-4323
Mailing Address - Fax:
Practice Address - Street 1:1222 SEPHOS ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8079
Practice Address - Country:US
Practice Address - Phone:209-456-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care