Individual
JASON DEREK MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA/OAP
Contact information
Practice address
5033 W AVENUE L10 APT 15, LANCASTER, CA 93536-3681
(661) 709-0637
Mailing address
5033 W AVENUE L10 APT 15, LANCASTER, CA 93536-3681
(661) 709-0637
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA84892
CA
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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