Healthcare Provider Details

I. General information

NPI: 1679494322
Provider Name (Legal Business Name): DESIREE MIRANDA SANCHEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E YOSEMITE AVE
MERCED CA
95340-9167
US

IV. Provider business mailing address

413 ROCKPORT DR UNIT 117
LOS BANOS CA
93635-8279
US

V. Phone/Fax

Practice location:
  • Phone: 209-724-5409
  • Fax:
Mailing address:
  • Phone: 408-722-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number694463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: