Healthcare Provider Details

I. General information

NPI: 1871408500
Provider Name (Legal Business Name): MIRANDA ROSE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 ALTO RD
BALTIMORE MD
21216-2002
US

IV. Provider business mailing address

122 N MILTON AVE
BALTIMORE MD
21224-1048
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-0595
  • Fax:
Mailing address:
  • Phone: 575-571-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03377L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: