Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 0056269 | CO |
N | 207PE0004X | Emergency Medical Services | A97929 | CA |
NPI | 1104004985 |
---|---|
Provider Name | Dr. Adrian Miranda |
First Address | Colorado Springs, CO 80920-1562 |
Second Address | Colorado Springs, CO 80920-1562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2008 |
Last Update Date | 27/12/2017 |