Healthcare Provider Details

I. General information

NPI: 1730092537
Provider Name (Legal Business Name): ALLAN MIRANDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 LA SIERRA AVE
RIVERSIDE CA
92505-2612
US

IV. Provider business mailing address

608 FEATHERWOOD DR
DIAMOND BAR CA
91765-1496
US

V. Phone/Fax

Practice location:
  • Phone: 951-525-3752
  • Fax: 951-358-0762
Mailing address:
  • Phone: 323-809-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: