Individual
DOMINIQUE NICOLE MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2437 FENTON ST STE B, CHULA VISTA, CA 91914-3517
(619) 361-5409
Mailing address
5402 ROMEGA CT, BONITA, CA 91902-2122
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
53473
CA
Other
Enumeration date
04/03/2025
Last updated
04/03/2025
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