Mira Integrated Holdings Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

98254 Issued in CA

Legal business name

MIRA INTEGRATED HOLDINGS INC

Doing business as

Supreme Healthcare

Practice address

433 W Allen Ave Ste 112
San Dimas, CA 91773-4704

Phone

(909) 657-5557

Fax

(909) 657-9990

NPI assigned

Feb 27, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Arnold Aquino

Title

President

Phone

(909) 657-5557

Specialties & licenses 1

Addresses

Other names 1

• Supreme Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1902307713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 W ALLEN AVE STE 112",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734704",
            "telephone_number": "909-657-5557",
            "fax_number": "909-657-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W ALLEN AVE STE 112",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917734704",
            "telephone_number": "909-657-5557",
            "fax_number": "909-657-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRA INTEGRATED HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-27",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "AQUINO",
        "authorized_official_first_name": "ARNOLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-657-5557",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "98254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Supreme Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anita T Miller-Ruiz
• Vanessa Miller
• Mind and Heart Family Counseling
• Megan Maria Minnick, LPCC
• Timothy Minnihan, RN
• Angeline Mitchell
• Kanan Modi, M.D.
• Roy H Moffatt, M.D.
• Jasmine B Moghadam, NURSE PRACTITIONER
• Mojtaba Moghadam I, M.D.

• Durable Medical Equipment & Medical Supplies in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.