Provider Demographics
NPI:1336382829
Name:MIRANDA, MARTA GRACIELA
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:GRACIELA
Last Name:MIRANDA
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 1:1141 PEAR TREE LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6484
Mailing Address - Country:US
Mailing Address - Phone:707-254-1770
Mailing Address - Fax:707-251-2993
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6484
Practice Address - Country:US
Practice Address - Phone:707-254-1770
Practice Address - Fax:707-251-2993
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator