Individual
DR. CONRAD J R MIRANDA IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9900 BALBOA BLVD, SUITE A, NORTHRIDGE, CA 91325-5403
(818) 701-0017
(818) 701-0073
Mailing address
9900 BALBOA BLVD, SUITE A, NORTHRIDGE, CA 91325-5403
(818) 701-0017
(818) 701-0073
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C51139
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C51139
PHYSICIAN CA LICENSE
CA
Enumeration date
06/09/2006
Last updated
07/08/2007
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