Healthcare Provider Details

I. General information

NPI: 1447137328
Provider Name (Legal Business Name): STEPHANIE M MIRANDA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N ORANGE GROVE BLVD # 207
PASADENA CA
91103-3333
US

IV. Provider business mailing address

2222 HUNTINGTON DR APT 51
DUARTE CA
91010-2025
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone: 626-367-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number256109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: