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Contact Information

LISA M MIRANDA, P.A.-C
568 N SUNRISE AVE STE 250
ROSEVILLE, CA95661
 Phone: 916-865-1140
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for LISA M MIRANDA · (Female)

NPI Number 1144314766
Status Active
Credentials P.A.-C
Entity Individual
Enumeration date 10/03/2006
Last updated 03/06/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • CA License # PA15570
  • TN License # PA1051
  • TN Medicaid 3661837
  • TN Other 2000307 BCBS OF TN
  • TN Other TN0102 JOHN DEERE
  • TN Other 970027904 RAILROAD MEDICARE
  • TN Other 621038898 TAX ID
  • TN Other 0140208 UNITED HEALTHCARE
  • TN Other FP62706 WORKERS COMP
Hospital affiliation(s)
  • SUTTER ROSEVILLE MEDICAL CENTER - (Acute Care)
    ONE MEDICAL PLAZA
    ROSEVILLE, CA 95661
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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