Active NPI
Raul Miranda, MD
- Adult Medicine Physician
- Costa Mesa, CA
National Provider Identifier
1407895006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- A049913
- Practice address
- 272 Victoria St
Ste. 2K
Costa Mesa, CA 92627-1974 - Phone
- (949) 646-1631
- Fax
- (949) 548-7475
- NPI assigned
- Jun 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | A049913 | CA | Primary |
Addresses
Primary practice location
272 Victoria St
Ste. 2K
Costa Mesa, CA 92627-1974
Mailing address
272 Victoria St
Ste. 2K
Costa Mesa, CA 92627-1974
Phone (949) 646-1631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120419000143 | CA | Practitioner - Family Practice | 9638330632 | Practice locations: Costa Mesa, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A049913 | CA | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280275200000",
"number": "1407895006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "272 VICTORIA ST",
"address_2": "STE. 2K",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926271974",
"telephone_number": "949-646-1631",
"fax_number": "949-548-7475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "272 VICTORIA ST",
"address_2": "STE. 2K",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926271974",
"telephone_number": "949-646-1631",
"fax_number": "949-548-7475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA",
"first_name": "RAUL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2010-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "CA",
"license": "A049913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.