Healthcare Provider Details

I. General information

NPI: 1053752444
Provider Name (Legal Business Name): MIRANDA SAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 07/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

15703 BEAVER RUN RD
CANYON COUNTRY CA
91387-4002
US

V. Phone/Fax

Practice location:
  • Phone: 805-577-0830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: