Provider Demographics
NPI:1952960528
Name:MIRANDA, MICHAELA KRYSTINE (MS)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:KRYSTINE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:MIRANDA
Other - Last Name:ROSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1651 RESPONSE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-5255
Mailing Address - Country:US
Mailing Address - Phone:916-518-3187
Mailing Address - Fax:
Practice Address - Street 1:1651 RESPONSE RD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5255
Practice Address - Country:US
Practice Address - Phone:916-518-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12610106E00000X
171M00000X
CA1-23-65363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator