Active NPI
Rafael Miranda, PA
- Physician Assistant
- San Diego, CA
National Provider Identifier
1609924521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA14588
- Practice address
- 4405 Vandever Ave
San Diego, CA 92120-3315 - Phone
- (619) 528-5000
- NPI assigned
- Jan 8, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA14588 | CA | Primary |
Addresses
Primary practice location
4405 Vandever Ave
San Diego, CA 92120-3315
Mailing address
393 E Walnut St
3Rd Floor PHR Systems
Pasadena, CA 91188-0001
Phone (626) 405-3640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA14588 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| California Em-I Medical Services, a Medical Corporation | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609924521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "393 E WALNUT ST",
"address_2": "3RD FLOOR PHR SYSTEMS",
"city": "PASADENA",
"state": "CA",
"postal_code": "911880001",
"telephone_number": "626-405-3640",
"fax_number": "626-405-6768"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4405 VANDEVER AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921203315",
"telephone_number": "619-528-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRANDA",
"first_name": "RAFAEL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA14588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- 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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.