Organization
KELLY MIRANDA PHYSICIAN ASSISTANT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY MIRANDA PA-C (PHYSICIAN ASSISTANT)
(909) 229-6886
Entity
Organization
Contact information
Practice address
26520 CACTUS AVE, MORENO VALLEY, CA 92555-3927
(951) 486-5690
Mailing address
12875 CANYONWIND RD, RIVERSIDE, CA 92503-9760
(909) 229-6886
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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