Provider Demographics
NPI:1942763701
Name:MIRANDA VALDEZ, JULISSA
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:MIRANDA VALDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 E MOSHOLU PKWY N APT 4E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4849
Mailing Address - Country:US
Mailing Address - Phone:646-525-6326
Mailing Address - Fax:
Practice Address - Street 1:387 E MOSHOLU PKWY N APT 4E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4849
Practice Address - Country:US
Practice Address - Phone:646-525-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator