Healthcare Provider Details

I. General information

NPI: 1376427047
Provider Name (Legal Business Name): CRISTINA MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23990 EUCALYPTUS AVE
MORENO VALLEY CA
92553-5504
US

IV. Provider business mailing address

6367 ARCHER ST
RIVERSIDE CA
92509-5065
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4710
  • Fax:
Mailing address:
  • Phone: 951-642-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: