Provider Demographics
NPI:1891152856
Name:MIRANDA, PATRICIA (MS, LCGC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH ST.
Mailing Address - Street 2:BOX 0706
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-9321
Mailing Address - Fax:415-476-9305
Practice Address - Street 1:550 16TH ST
Practice Address - Street 2:BOX 0706
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2549
Practice Address - Country:US
Practice Address - Phone:415-476-9321
Practice Address - Fax:415-476-9305
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000570170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS