Individual
INJA MIRANDA OH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6502 LOTUS ST, EASTVALE, CA 92880-0778
(831) 220-2163
Mailing address
6502 LOTUS ST, EASTVALE, CA 92880-0778
(831) 220-2163
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
42612
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F7537113
DRIVE LICENSE
CA
Enumeration date
02/02/2022
Last updated
02/02/2022
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