Individual
MR. IVAN MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
16479 DALLAS PKWY STE 320, ADDISON, TX 75001-6709
(469) 484-4260
Mailing address
16479 DALLAS PKWY STE 320, ADDISON, TX 75001-6709
(469) 484-4260
(469) 484-4265
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA17718
TX
363AM0700X
Medical Physician Assistant
Primary
PA17718
TX
Other
Enumeration date
06/23/2022
Last updated
12/16/2025
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