Provider Demographics
NPI:1285087668
Name:MIRA, BIANCA ESTHER
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:ESTHER
Last Name:MIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 AIRPORT BLVD STE 490&495
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1908
Mailing Address - Country:US
Mailing Address - Phone:650-517-8210
Mailing Address - Fax:650-620-9549
Practice Address - Street 1:700 AIRPORT BLVD STE 490&495
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1908
Practice Address - Country:US
Practice Address - Phone:650-517-8210
Practice Address - Fax:650-620-9549
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker