Provider Demographics
NPI:1821838517
Name:MIRANDA, ANGELA TAVA (JD, MD, LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:TAVA
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:JD, MD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4521
Mailing Address - Country:US
Mailing Address - Phone:210-259-3995
Mailing Address - Fax:
Practice Address - Street 1:7254 BLANCO RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4930
Practice Address - Country:US
Practice Address - Phone:512-256-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health