Healthcare Provider Details

I. General information

NPI: 1952925927
Provider Name (Legal Business Name): TANIA YESSENIA PEREZ MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HARBOR BLVD STE 910
ANAHEIM CA
92805-3721
US

IV. Provider business mailing address

12440 FIRESTONE BLVD STE 3001
NORWALK CA
90650-4300
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax: 562-362-3137
Mailing address:
  • Phone: 866-869-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: