Provider Demographics
NPI:1265114169
Name:MIRANDA, ALICE ELIZABETH (SLPA)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ELIZABETH
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 KELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4206
Mailing Address - Country:US
Mailing Address - Phone:951-847-4517
Mailing Address - Fax:
Practice Address - Street 1:11870 PIERCE ST STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-6600
Practice Address - Country:US
Practice Address - Phone:951-808-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79932355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant