Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33240 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33240 | CA |
NPI | 1164915237 |
---|---|
Provider Name | Dr. Denise Lizbeth Miranda |
First Address | Palmdale, CA 93551-1068 |
Second Address | Lancaster, CA 93534-7089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 12/06/2018 |