Healthcare Provider Details

I. General information

NPI: 1396631834
Provider Name (Legal Business Name): JAYAH MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 MURRAY AVE STE 100
GILROY CA
95020-3675
US

IV. Provider business mailing address

1296 WEST ST
HOLLISTER CA
95023-4716
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-7138
  • Fax:
Mailing address:
  • Phone: 831-205-8978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: