Healthcare Provider Details

I. General information

NPI: 1548139355
Provider Name (Legal Business Name): JOANA MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 W AVENUE L12
LANCASTER CA
93534-7083
US

IV. Provider business mailing address

45800 CHALLENGER WAY SPC 134
LANCASTER CA
93535-1402
US

V. Phone/Fax

Practice location:
  • Phone: 424-442-9129
  • Fax:
Mailing address:
  • Phone: 424-442-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: