Provider Demographics
NPI:1881298800
Name:MIRANDA, ROSA AMELIA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:AMELIA
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:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:PAUMA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92061-1267
Mailing Address - Country:US
Mailing Address - Phone:760-215-7959
Mailing Address - Fax:
Practice Address - Street 1:32839 RINCON RANCH RD
Practice Address - Street 2:
Practice Address - City:PAUMA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92061
Practice Address - Country:US
Practice Address - Phone:760-215-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician