Provider Demographics
NPI:1679817043
Name:MIRANDA, ROBERTA ANGELA (LADC, CPC, NCC, ACS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ANGELA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:LADC, CPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4100
Mailing Address - Country:US
Mailing Address - Phone:702-204-3609
Mailing Address - Fax:
Practice Address - Street 1:2000 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-4100
Practice Address - Country:US
Practice Address - Phone:702-204-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-24
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLADC #1160101YA0400X
NVNCC#204921101YP2500X
NVCPC#0049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)