Individual
MR. JUAN LUIS MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13075 W MCDOWELL RD STE D106, AVONDALE, AZ 85323-6437
(800) 819-8566
Mailing address
16410 S 41ST ST, PHOENIX, AZ 85048-0552
(480) 272-7856
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3275
AZ
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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