DR. CONRAD J R MIRANDA IV (NPI# 1073554168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073554168 |
| Entity Type | Individual |
| Full Name | DR. CONRAD J R MIRANDA IV |
| Credential | M.D. |
| Practice Address |
9900 Balboa Blvd Suite A Northridge CA 91325-5403 |
| Practice Telephone | 8187010017 |
| Practice Fax Number | 8187010073 |
| Mailing Telephone | 8187010017 |
| Mailing Fax Number | 8187010073 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | C51139 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PHYSICIAN CA LICENSE | C51139 | 01 |
| Street Address |
9900 BALBOA BLVD SUITE A |
| City | NORTHRIDGE |
| State | CA |
| Zip Code | 91325-5403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366731762 | Raeesy Md Inc | Internal Medicine | 9900 Balboa Blvd, Suite A, Northridge, CA 91325-5403 | 2011-04-06 |
| 1467753038 | Lidia Mendoza | Massage Therapist | 9900 Balboa Blvd, Suite B, Northridge, CA 91325-5403 | 2010-11-12 |
| 1902106560 | Stacey Kikumi Naito | Dermatology | 9900 Balboa Blvd, Suite E, Northridge, CA 91325-5403 | 2010-10-29 |
| 1487822086 | Khatul Andkhoy | Acupuncturist | 9900 Balboa Blvd, Suite B, Northridge, CA 91325-5403 | 2008-02-15 |
| 1215132238 | Balboa Medical & Wellness Center,inc. | General Practice | 9900 Balboa Blvd, Suite E, Northridge, CA 91325-5403 | 2007-06-19 |
| 1629130281 | Jae Seob Kim | Acupuncturist | 9900 Balboa Blvd, Suite A, Northridge, CA 91325-5403 | 2006-12-13 |
| 1124189501 | Hee Jong L Choi | Acupuncturist | 9900 Balboa Blvd, Suite A, Northridge, CA 91325-5403 | 2006-12-12 |
| 1689756132 | Northridge Physical Therapy Center,inc | Physical Therapist | 9900 Balboa Blvd, Suite C, Northridge, CA 91325-5403 | 2006-10-20 |
| 1417044132 | Amir Homayon Raeesy-nezhad | Internal Medicine | 9900 Balboa Blvd, Suite A, Northridge, CA 91325-5403 | 2006-10-06 |
| 1407869928 | Great Spirit Medical Group,inc | Family Medicine | 9900 Balboa Blvd, Suite A, Northridge, CA 91325-5403 | 2006-08-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396346961 | Patricia Yamilet Morales | Registered Nurse | 18300 Roscoe Blvd Dignity Health- Northridge Hospital M, Northridge, CA 91325 | 2020-11-02 |
| 1790342897 | Northridge Kidney Center, LLC | Clinic/Center | 17710 Roscoe Blvd, Northridge, CA 91325 | 2019-05-23 |
| 1063078376 | Ozlem Alper | Student in an Organized Health Care Education/Training Program | 18497 Dearborn St, Unit 112, Northridge, CA 91325 | 2019-05-13 |
| 1144883489 | Better Sober | Clinic/Center | 9339 Louse Ave, Northridge, CA 91325 | 2019-04-22 |
| 1902383920 | Ntr Resources, LLC | Pathology | 17433 Nordhoff, Northridge, CA 91325 | 2018-07-23 |
| 1043713969 | Poly-med Pharmacy Inc | Pharmacy | 17313 Roscoe Blvd, Northridge, CA 91325 | 2018-03-16 |
| 1982151940 | Maria Dakessian | Dentist | 18250 Roscoe Blvd Ste 345, Northridge, CA 91325 | 2016-09-07 |
| 1487019469 | Beshoy Gerges | Pharmacist | 8254 White Oak Ave Unit 4, Northridge, CA 91325 | 2015-12-17 |
| 1235520305 | Gema Bautista | Social Worker | 8550 Balboa Blvd Ste 216, Northridge, CA 91325 | 2015-02-11 |
| 1083018873 | Sosann Haider | Pharmacist | 18444 Plummer St., Northridge, CA 91325 | 2014-10-22 |
| Find all providers in zip 91325 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043360225 | Jacob Jay Lorber | General Practice | 10453 Yolanda Ave, Northridge, CA 91326-3439 | 2007-01-11 |
| 1568482461 | Kiran P Dua | General Practice | 8349 Reseda Blvd, Suite G, Northridge, CA 91324-5914 | 2006-07-20 |
| 1891086369 | David Frederick Velkoff | General Practice | 18250 Roscoe Blvd., Suite 325, Northridge, CA 91325 | 2011-05-02 |
| 1336475334 | All for Health Medical Center, Inc. | General Practice | 8700 Reseda Blvd, Ste 202, Northridge, CA 91324-4041 | 2009-10-26 |
| 1073847364 | Moore Care Providers | General Practice | 8860 Corbin Ave, Ste 386, Northridge, CA 91324-3309 | 2009-09-20 |
| 1962699926 | Lee Richard Brautman | General Practice | 18111 Nordhoff St, Northridge, CA 91330-8270 | 2007-10-03 |
| 1215132238 | Balboa Medical & Wellness Center,inc. | General Practice | 9900 Balboa Blvd, Suite E, Northridge, CA 91325-5403 | 2007-06-19 |
| 1083836803 | Rahil Khan Md, Inc. | General Practice | 8349 Reseda Blvd, Northridge, CA 91324-4622 | 2007-05-02 |
| 1780700898 | Ashima Sharma | General Practice | 9650 Zelzah Ave, Northridge, CA 91325-2003 | 2007-03-21 |
| 1215993167 | Victor S Hogen & Associates Medical Group Inc | General Practice | 18433 Roscoe Blvd, Ste 204, Northridge, CA 91325 | 2006-04-20 |
| Find all providers in NORTHRIDGE | ||||
| City | NORTHRIDGE |
| Zip Code | 91325 |
Please comment or provide details below to improve the information on DR. CONRAD J R MIRANDA IV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.