Individual
RAQUEL MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2604 S VERMONT AVE STE F, LOS ANGELES, CA 90007-2298
(323) 731-3333
(323) 731-7626
Mailing address
617 W 75TH ST APT 4, LOS ANGELES, CA 90044-6153
(323) 842-7870
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA72406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA72406
—
CA
Enumeration date
11/11/2020
Last updated
11/11/2020
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