MEDICARE: ROSA AMELIA MIRANDA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1881298800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA AMELIA MIRANDA

Provider Business Mailing Address
First Line	:	PO BOX 1267
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061-1267
Country	:	US
Telephone Number	:	760-215-7959
Fax Number	:

Provider Business Practice Location Address
First Line	:	32839 RINCON RANCH RD
Second Line	:
City	:	PAUMA VALLEY
State	:	CA
Zip	:	92061
Country	:	US
Telephone Number	:	760-215-5975
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ ROSA AMELIA MIRANDA ” Practice Location

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