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General NPI Number Information
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NPI Number | 1568021392
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Entity Type | Individual
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Provider Name | MAYOLA MIRANDA LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 2204 S EL CAMINO REAL STE 305
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City | OCEANSIDE
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State | CA
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Zip | 92054-6306
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Country | US
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Telephone | 619-763-8945
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Fax | 855-706-2058
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Provider Business Mailing Address
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Address Line | PO BOX 6884
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City | ORANGE
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State | CA
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Zip | 92863-6884
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Country | US
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Telephone | 760-509-2360
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Fax | 855-706-2058
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW24899
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License Number State | CA
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