Active NPI
Nelson Domingo Miranda, LVN
- Licensed Vocational Nurse
- Pasadena, CA
National Provider Identifier
1083872204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- VN224991
- Practice address
- 2555 E Colorado Blvd
Suite 100
Pasadena, CA 91107-6622 - Phone
- (626) 577-2261
- Fax
- (626) 577-2543
- NPI assigned
- May 23, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | VN224991 | CA | Primary |
Addresses
Primary practice location
2555 E Colorado Blvd
Suite 100
Pasadena, CA 91107-6622
Mailing address
PO Box 1292
Arcadia, CA 91077-1292
Phone (818) 653-6969
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ICAN807 | Other | CA | LA COUNTY DMH STAFF CODE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VN224991 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211500800000",
"number": "1083872204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1292",
"city": "ARCADIA",
"state": "CA",
"postal_code": "910771292",
"telephone_number": "818-653-6969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 E COLORADO BLVD",
"address_2": "SUITE 100",
"city": "PASADENA",
"state": "CA",
"postal_code": "911076622",
"telephone_number": "626-577-2261",
"fax_number": "626-577-2543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA",
"first_name": "NELSON",
"middle_name": "DOMINGO",
"name_prefix": "Mr.",
"credential": "LVN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-23",
"last_updated": "2008-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "VN224991",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA COUNTY DMH STAFF CODE",
"identifier": "ICAN807",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.