Provider Demographics
NPI:1124320213
Name:JAVIER E. MIRO, M.D., INC
Entity type:Organization
Organization Name:JAVIER E. MIRO, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-665-0505
Mailing Address - Street 1:3838 SAN DIMAS ST STE B231
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1494
Mailing Address - Country:US
Mailing Address - Phone:661-665-0505
Mailing Address - Fax:661-665-7844
Practice Address - Street 1:3838 SAN DIMAS ST STE B231
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1494
Practice Address - Country:US
Practice Address - Phone:661-665-0505
Practice Address - Fax:661-665-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA417572086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29454Medicare UPIN