# KELLY MIRANDA PHYSICIAN ASSISTANT INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245887645
- **Authorized official:** MS. KELLY MIRANDA PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (909) 229-6886

## Contact information

- **Practice address:** 26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
- **Practice address phone:** (951) 486-5690
- **Mailing address:** 12875 CANYONWIND RD, RIVERSIDE, CA 92503-9760
- **Mailing address phone:** (909) 229-6886

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/20/2019
- **Last updated:** 08/20/2019