Provider Demographics
NPI:1922336544
Name:MIRANDA, IVANIA
Entity Type:Individual
Prefix:
First Name:IVANIA
Middle Name:
Last Name:MIRANDA
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 1:27864 SW 139TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6691
Mailing Address - Country:US
Mailing Address - Phone:786-712-9825
Mailing Address - Fax:
Practice Address - Street 1:20520 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-5408
Practice Address - Country:US
Practice Address - Phone:786-712-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst