Healthcare Provider Details

I. General information

NPI: 1568307817
Provider Name (Legal Business Name): MIRANDA EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 S PLANO ST # CA
PORTERVILLE CA
93257-6026
US

IV. Provider business mailing address

2021 GRISMER AVE APT 35
BURBANK CA
91504-3638
US

V. Phone/Fax

Practice location:
  • Phone: 559-783-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: