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General NPI Number Information
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NPI Number | 1225222557
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Entity Type | Individual
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Provider Name | DESIREE EILEEN MIRANDA VEGA MFT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 11145 TAMPA AVE STE 15A
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City | NORTHRIDGE
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State | CA
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Zip | 91326
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Country | US
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Telephone | 818-427-3891
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Fax | 818-855-7428
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Provider Business Mailing Address
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Address Line | 1662 FREMONT AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93065-4524
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Country | US
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Telephone | 818-427-3891
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Fax | 818-855-7428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | IMF50330
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License Number State | CA
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