Healthcare Provider Details

I. General information

NPI: 1235445289
Provider Name (Legal Business Name): MIRANDA ALEXANDER PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 GAYLEY AVE FL 3
LOS ANGELES CA
90024-3423
US

IV. Provider business mailing address

1145 GAYLEY AVE FL 3
LOS ANGELES CA
90024-3423
US

V. Phone/Fax

Practice location:
  • Phone: 641-844-3120
  • Fax:
Mailing address:
  • Phone: 641-844-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: