Provider Demographics
NPI:1326818766
Name:MIRANDA-SOSA, KARLA I
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:
Last Name:MIRANDA-SOSA
Suffix:I
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 1:26241 OSHUA DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-2491
Mailing Address - Country:US
Mailing Address - Phone:951-867-2869
Mailing Address - Fax:
Practice Address - Street 1:26241 OSHUA DR
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-2491
Practice Address - Country:US
Practice Address - Phone:951-867-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician