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NPI Code Detail

MEDICARE: MIRANDA LORRAINE DINKINS

MEDICARE: MIRANDA LORRAINE DINKINS
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
1101YM0800XMental Health CounselorASW86261CA
21041C0700XClinical Social Worker112648CA

General Provider Information

NPI Number : 1578100582
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA LORRAINE DINKINS
Provider Business Mailing Address
First Line : 2605 MADISON AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-3048
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5855 STREAMVIEW DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-3910
Country : US
Telephone Number : 619-287-5460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2019
Last Update Date : 03/21/2023

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Directions to “ MIRANDA LORRAINE DINKINS ” Practice Location

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