Provider Demographics
NPI:1942197959
Name:ZULETA MIRANDA, RAFAEL FELIPE
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:FELIPE
Last Name:ZULETA MIRANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 CEDARVILLE LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-2077
Mailing Address - Country:US
Mailing Address - Phone:240-678-2819
Mailing Address - Fax:
Practice Address - Street 1:202 GLACIER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4826
Practice Address - Country:US
Practice Address - Phone:925-229-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program