Conrad J R Miranda IV, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C51139 Issued in CA

Practice address

9900 Balboa Blvd
Suite a
Northridge, CA 91325-5403

Phone

(818) 701-0017

Fax

(818) 701-0073

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Balboa Medical & Wellness Center,Inc.

  • General Practice Physician
  • Northridge, CA
  • NPI 1215132238
  NPD (past)
• Kronos Cardia Medical Group, Inc

  • Cardiovascular Disease Physician
  • Torrance, CA
  • NPI 1972541480
  NPD (past)
• Raeesy MD Inc

  • Internal Medicine Physician
  • Encino, CA
  • NPI 1366731762
  NPD (past)
• Toluca Lake Medical Center Inc

  • General Practice Physician
  • Toluca Lake, CA
  • NPI 1346482601
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073554168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 BALBOA BLVD",
            "address_2": "SUITE A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255403",
            "telephone_number": "818-701-0017",
            "fax_number": "818-701-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 BALBOA BLVD",
            "address_2": "SUITE A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255403",
            "telephone_number": "818-701-0017",
            "fax_number": "818-701-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRANDA",
        "first_name": "CONRAD",
        "middle_name": "J R",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "C51139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN  CA LICENSE",
            "identifier": "C51139",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitra Minovi
• Miracle-Ear, Inc.
• Miracles in Action LLC
• Miracles in Action, LLC
• Ellie Miraftabi, PH.D., MFT
• Darrel Martin Miranda
• Haydee Miranda
• Luz Liliana Miranda, MSW
• Inessa Miretsky, PHARM.D.
• Howard Leonard Misheloff, O.D.

• General Practice Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.