Most Relevant Information
Provider Data
| NPI Number: | 1003547670 |
| Provider Name: | IVAN MIRANDA PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | PA17718 |
Most Important Dates
| Enumeration Date: | 06/23/2022 |
| Last Updated: | 04/02/2024 |
Provider Practice Location
16479 DALLAS PKWY STE 320
ADDISON
TX
750016709
Practice Location Phone/Fax
| Phone: | 4694844260 |
| Fax: |
Provider Mailing Location
16479 DALLAS PKWY STE 320
ADDISON
TX
750016709
Provider Mailing Phone/Fax
| Phone: | 4694844260 |
| Fax: | 4694844265 |