Provider Demographics
NPI:1962291294
Name:MIRANDA, ROMAN (RN)
Entity type:Individual
Prefix:MR
First Name:ROMAN
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-3668
Mailing Address - Country:US
Mailing Address - Phone:520-604-5407
Mailing Address - Fax:
Practice Address - Street 1:1151 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-3668
Practice Address - Country:US
Practice Address - Phone:520-604-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95416147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse