Healthcare Provider Details

I. General information

NPI: 1124495734
Provider Name (Legal Business Name): VALERIE MIRANDA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10080 AMHERST AVE
MONTCLAIR CA
91763-3003
US

IV. Provider business mailing address

10080 AMHERST AVE
MONTCLAIR CA
91763-3003
US

V. Phone/Fax

Practice location:
  • Phone: 909-486-9401
  • Fax:
Mailing address:
  • Phone: 909-486-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: