MRS. LISA M MIRANDA (NPI# 1144314766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144314766 |
| Entity Type | Individual |
| Full Name | MRS. LISA M MIRANDA |
| Credential | P.A.-C |
| Practice Address |
568 N Sunrise Ave Ste 250 Roseville CA 95661 |
| Mailing Address |
10470 Old Placerville Rd Ste 100 Sacramento CA 95827-2539 |
| Practice Telephone | 9168651140 |
| Mailing Telephone | 8004700071 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-03-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA15570 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA1051 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | TAX ID | 621038898 | 01 |
| TN | WORKERS COMP | FP62706 | 01 |
| TN | UNITED HEALTHCARE | 0140208 | 01 |
| TN | BCBS OF TN | 2000307 | 01 |
| TN | 3661837 | 05 | |
| TN | JOHN DEERE | TN0102 | 01 |
| TN | RAILROAD MEDICARE | 970027904 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2121 North Ocoee Street, Suite 101, Cleveland, TN 37311 | 4234726548 | 4234728318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841438165 | Lisa Antoenette Miranda | Psychologist | 62 Calle Comercio, Ponce, PR 00730-5003 | 2009-01-23 |
| Street Address |
568 N SUNRISE AVE STE 250 |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95661 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407376106 | Kyle Clark Smith | Family Medicine | 568 N Sunrise Ave Ste 250, Roseville, CA 95661-3097 | 2017-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134777816 | Aprildawn Mccarty Mccarty | Behavior Technician | 2125 Professional Dr, 100, Roseville, CA 95661 | 2019-08-27 |
| 1407409089 | David Armel Gomez Croddy | Dentist | 2740 Carradale Drive, Roseville, CA 95661 | 2019-07-22 |
| 1699335612 | Mowell | Durable Medical Equipment & Medical Supplies | 901 Sunrise, Roseville, CA 95661 | 2019-06-20 |
| 1578024998 | Mystesia Lasan Hayes | Behavior Technician | 4121 Vittorio Dr., Roseville, CA 95661 | 2019-03-28 |
| 1033676457 | The Place Within | Counselor | 720 Sunrise Ave #d115, Roseville, CO 95661 | 2019-02-21 |
| 1396217733 | Tuyen Thi Thanh Nguyen | Respiratory Therapist, Registered | Kaiser Roseville Hospital, 1600 Eureka Rd, Roseville, CA 95661 | 2018-12-26 |
| 1982179776 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 1565 Eureka Road, Suite 5, Roseville, CA 95661 | 2018-10-08 |
| 1184106536 | Sabita Kondle | Marriage & Family Therapist | 1528 Hope Counseling Center Ste 101, Roseville, CA 95661 | 2018-09-02 |
| 1740787837 | Sylvia A Atieno | Nurse Practitioner | Suttter Roseville Medical Center, 1 Medical Plaza, Roseville, CA 95661 | 2018-04-06 |
| 1457875296 | Good Works Psychophysiology and Physical Therapy | Physical Therapist | 1650 Leadhill Blvd, 600, Roseville, CA 95661 | 2017-08-02 |
| Find all providers in zip 95661 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538781372 | Jacob Adam Novick | Physician Assistant | 1346 Stonebridge Way, Roseville, CA 95661-5457 | 2020-05-14 |
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1689212482 | Meghan Licciardello | Physician Assistant | 300 Harding Blvd Ste 213, Roseville, CA 95678-2474 | 2019-12-12 |
| 1710541016 | Khine Mira Tian | Physician Assistant | 2780 Snelling Ave N Ste 304, Roseville, MN 55113-7125 | 2019-04-23 |
| 1093287161 | Michael Eugeniuscz Froniewski | Physician Assistant | 1544 Eureka Rd Ste 160, Roseville, CA 95661-3092 | 2018-12-29 |
| 1528547106 | Steven Charles Frank | Physician Assistant | 11801 Go for Broke Rd, Roseville, CA 95678-7055 | 2018-08-14 |
| 1710392196 | Linda Ly Luong | Physician Assistant | 781 Pleasant Grove Blvd Ste 170, Roseville, CA 95678 | 2014-06-24 |
| 1487995924 | Judy Garcia Tumber | Physician Assistant | 8727 Wentworth Ct, Roseville, CA 95747-6370 | 2013-03-07 |
| 1598049249 | Ann Barbeiro | Physician Assistant | 8207 Sierra College Blvd Ste 500, Roseville, CA 95661-9407 | 2011-09-29 |
| 1164686937 | Julie Hunn | Physician Assistant | 729 Sunrise Ave Ste 900, Roseville, CA 95661-4525 | 2008-07-10 |
| Find all providers in ROSEVILLE | ||||
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| 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.