Provider Demographics
NPI:1184216723
Name:MIRANDA, CLAUDIA ALEJANDRA
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ALEJANDRA
Last Name:MIRANDA
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 1:16079 YARNELL ST SPC C8
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-0702
Mailing Address - Country:US
Mailing Address - Phone:818-723-1212
Mailing Address - Fax:
Practice Address - Street 1:16079 YARNELL ST SPC C8
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-0702
Practice Address - Country:US
Practice Address - Phone:818-723-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician