MEDICARE: MR. RAINIERO MIRANDA MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MFC36303	CA
2	106H00000X	Marriage & Family Therapist	MFC36303	CA

General Provider Information

NPI Number	:	1447354634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAINIERO MIRANDA MFT

Provider Business Mailing Address
First Line	:	753 CENTER BLVD # C
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1764
Country	:	US
Telephone Number	:	415-672-9367
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 CENTER BLVD # C
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1764
Country	:	US
Telephone Number	:	415-672-9367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	03/28/2025

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