Provider Demographics
NPI:1871124396
Name:MIRANDA, RUTH ALICIA (MPPD, RDN, LD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ALICIA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MPPD, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 EL PASEO DR
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7517
Mailing Address - Country:US
Mailing Address - Phone:915-243-2370
Mailing Address - Fax:
Practice Address - Street 1:5625 WOODROW BEAN STE 117
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4125
Practice Address - Country:US
Practice Address - Phone:915-243-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education