Healthcare Provider Details

I. General information

NPI: 1952960528
Provider Name (Legal Business Name): MICHAELA KRYSTINE MIRANDA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA MIRANDA ROSAS

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

V. Phone/Fax

Practice location:
  • Phone: 916-518-3187
  • Fax:
Mailing address:
  • Phone: 916-518-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number12610
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: