Healthcare Provider Details

I. General information

NPI: 1225973779
Provider Name (Legal Business Name): MIRIAM S FICKEWIRTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25527 FLANDERS DR
CARMEL CA
93923-8325
US

IV. Provider business mailing address

25527 FLANDERS DR
CARMEL CA
93923-8325
US

V. Phone/Fax

Practice location:
  • Phone: 831-626-1032
  • Fax: 831-626-0824
Mailing address:
  • Phone: 831-626-1032
  • Fax: 831-626-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number270708695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: