Healthcare Provider Details

I. General information

NPI: 1497609200
Provider Name (Legal Business Name): ADRIANA MIRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE A2
EVERETT WA
98208-3832
US

IV. Provider business mailing address

4613 73RD PL NE UNIT B
MARYSVILLE WA
98270-3709
US

V. Phone/Fax

Practice location:
  • Phone: 425-247-6863
  • Fax:
Mailing address:
  • Phone:
  • Fax: 425-312-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: