Provider Demographics
NPI:1457013096
Name:MIRANDA, VICTORIA (MHA, DOULA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MHA, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 NW SKYLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6849
Mailing Address - Country:US
Mailing Address - Phone:971-279-2230
Mailing Address - Fax:
Practice Address - Street 1:489 NW SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6849
Practice Address - Country:US
Practice Address - Phone:971-279-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty