Individual
MARK ANTHONY PATATAG MIRANDA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
65 WEDGEWOOD PL, BRIDGEPORT, CT 06606-1927
(323) 365-4549
Mailing address
65 WEDGEWOOD PL, BRIDGEPORT, CT 06606-1927
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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