Provider Demographics
NPI:1063420065
Name:MIRANDA, CRES P JR (MD)
Entity type:Individual
Prefix:DR
First Name:CRES
Middle Name:P
Last Name:MIRANDA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 E SILVERADO RANCH BLVD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7516
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-804-0957
Practice Address - Street 1:401 N BUFFALO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0397
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-804-0957
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6467207RC0000X, 207RI0011X
CAG62821207RC0000X
AZ23417207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002411Medicaid
NV103061Medicare PIN
C19451Medicare UPIN