Healthcare Provider Details

I. General information

NPI: 1194525667
Provider Name (Legal Business Name): FRANCISCO MIRANDA PTA, MASSAGETHERAPIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43979 15TH ST W
LANCASTER CA
93534-4635
US

IV. Provider business mailing address

41770 12TH ST W
PALMDALE CA
93551-1424
US

V. Phone/Fax

Practice location:
  • Phone: 661-522-3711
  • Fax: 661-522-3114
Mailing address:
  • Phone: 661-236-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: