Healthcare Provider Details

I. General information

NPI: 1679405690
Provider Name (Legal Business Name): MIRANDA ELAYNE GORDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD STE 350
CARLSBAD CA
92011-1451
US

IV. Provider business mailing address

250 N CITY DR APT 212
SAN MARCOS CA
92078-4420
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-2460
  • Fax:
Mailing address:
  • Phone: 559-334-5371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: