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General NPI Number Information
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NPI Number | 1811787674
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Entity Type | Individual
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Provider Name | JESSIE EMMANUEL MIRANDA
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Gender | Male
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 6649 AMETHYST AVE UNIT 9321
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-1557
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Country | US
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Telephone | 909-579-2524
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Fax |
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Provider Business Mailing Address
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Address Line | 15558 OLD CASTLE RD
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City | FONTANA
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State | CA
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Zip | 92337-0966
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Country | US
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Telephone | 909-746-9282
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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