MEDICARE: MIRANDA XUAN NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	129570	CA

General Provider Information

NPI Number	:	1154271732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA XUAN NGUYEN

Provider Business Mailing Address
First Line	:	2601 BLANDING AVE
Second Line	:	STE C PMB 369
City	:	ALAMEDA
State	:	CA
Zip	:	94501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 BLANDING AVE
Second Line	:	STE C PMB 369
City	:	ALAMEDA
State	:	CA
Zip	:	94501
Country	:	US
Telephone Number	:	951-445-9265
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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