Provider Demographics
NPI:1588739379
Name:JOSHI, MIRA BHARAT (MD)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:BHARAT
Last Name:JOSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E. 11TH ST.
Mailing Address - Street 2:STE 102
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-985-0883
Mailing Address - Fax:909-920-0045
Practice Address - Street 1:811 E 11TH ST
Practice Address - Street 2:STE 102
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4871
Practice Address - Country:US
Practice Address - Phone:909-985-0883
Practice Address - Fax:909-920-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA324430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF17192Medicare UPIN