Individual provider · NPI-1

Jermyn Douglas Miranda

Rehabilitation Practitioner · Mountain View, CA

NPI number1689032419
StatusActive
Last updated in NPPESJun 2, 2025

Details

NPI
1689032419
Entity type
Individual (NPI-1)
Name
Jermyn Douglas Miranda
Sex
Male
Sole proprietor
Yes
Enumeration date
Feb 8, 2016
Certification date
Jun 2, 2025
Last updated
Jun 2, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225400000X Rehabilitation Practitioner––Yes
171M00000X Case Manager/Care Coordinator––
172V00000X Community Health Worker––

Other names

  • Jermyndouglas Miranda (Other Name)

Practice location

1503 Grant Rd Ste 110
Mountain View, CA 94040-3270

Phone 650-484-1213 · Fax 408-642-6052

Mailing address

1503 Grant Rd Ste 110
Mountain View, CA 94040-3270

Phone 408-261-7777 · Fax 408-642-6052

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