Healthcare Provider Details

I. General information

NPI: 1316157555
Provider Name (Legal Business Name): KELLEE MILES-MARANZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 BROADWAY # B297
PLACERVILLE CA
95667-5900
US

IV. Provider business mailing address

1390 BROADWAY # B297
PLACERVILLE CA
95667-5900
US

V. Phone/Fax

Practice location:
  • Phone: 925-519-3375
  • Fax:
Mailing address:
  • Phone: 925-519-3375
  • Fax: 925-666-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: