Jeremy Miera
Individual provider Active NPI Contractor · Rio Rancho, NM
NPI 1124493085 · NPPES record last updated Dec 3, 2015
Key facts
- NPI
- 1124493085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 3174 (NM)
- Practice address
- 2557 Chessman Dr NE
Rio Rancho, NM 87124-6517 - Phone
- (505) 720-3941
- NPI assigned
- Dec 3, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 3174 | NM | Yes |
Addresses
Primary practice location
2557 Chessman Dr NE
Rio Rancho, NM 87124-6517
Mailing address
2557 Chessman Dr NE
Rio Rancho, NM 87124-6517
Phone (505) 720-3941
Other providers in Rio Rancho, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.