Healthcare Provider Details

I. General information

NPI: 1760321475
Provider Name (Legal Business Name): SONIA M MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 40TH ST S APT 109
FARGO ND
58103-1160
US

IV. Provider business mailing address

511 40TH ST S APT 109
FARGO ND
58103-1160
US

V. Phone/Fax

Practice location:
  • Phone: 661-713-2027
  • Fax: 661-713-2027
Mailing address:
  • Phone: 661-713-2027
  • Fax: 661-713-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: