Provider Demographics
NPI:1699294827
Name:MIRANDA, MAYRA (LVN)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N LAKE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2388
Mailing Address - Country:US
Mailing Address - Phone:626-794-1161
Mailing Address - Fax:
Practice Address - Street 1:1450 N LAKE AVE STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2388
Practice Address - Country:US
Practice Address - Phone:626-794-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693049164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse