Provider Demographics
NPI:1558545038
Name:MIRANDA, GEORGE GUINTO (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:GUINTO
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26691 PLAZA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8582
Mailing Address - Country:US
Mailing Address - Phone:949-347-0600
Mailing Address - Fax:949-347-0746
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:STE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8582
Practice Address - Country:US
Practice Address - Phone:949-347-0600
Practice Address - Fax:949-347-0746
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6022199-1205207RH0003X
CAA106771207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM9597925OtherDEA