Provider Demographics
NPI:1518599653
Name:FLOREZ, MIRANDA QUINN
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:QUINN
Last Name:FLOREZ
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 1:8589 LARK DR
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-5332
Mailing Address - Country:US
Mailing Address - Phone:707-540-2298
Mailing Address - Fax:
Practice Address - Street 1:8589 LARK DR
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-5332
Practice Address - Country:US
Practice Address - Phone:707-540-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst