Provider Demographics
NPI:1427603539
Name:TERRONES, MIRANDA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:TERRONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:BANUELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:400 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4353
Mailing Address - Country:US
Mailing Address - Phone:805-682-7111
Mailing Address - Fax:805-735-4293
Practice Address - Street 1:400 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4353
Practice Address - Country:US
Practice Address - Phone:805-682-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant