Individual provider Active NPI

Miranda L Yousif

  • Student in an Organized Health Care Education/Training Program
  • Phoenix, AZ
National Provider Identifier
1104684232
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
26224 N Tatum Blvd Ste 5
Phoenix, AZ 85050-7500
Phone
(480) 882-7580
NPI assigned
Mar 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

26224 N Tatum Blvd Ste 5
Phoenix, AZ 85050-7500

Mailing address

26224 N Tatum Blvd Ste 5
Phoenix, AZ 85050-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250709004483 AZ Order and Referring Only - DermatologyPractitioner - Dermatology 2264946342

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1104684232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26224 N TATUM BLVD STE 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26224 N TATUM BLVD STE 5",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850507500",
            "telephone_number": "480-882-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUSIF",
        "first_name": "MIRANDA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.