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NPI Code Detail

MEDICARE: MICHAELA KRYSTINE MIRANDA M.S.

MEDICARE: MICHAELA KRYSTINE MIRANDA M.S.
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
1106E00000XAssistant Behavior Analyst12610UT
2171M00000XCase Manager/Care Coordinator
3103K00000XBehavior Analyst1-23-65363CA

General Provider Information

NPI Number : 1952960528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAELA KRYSTINE MIRANDA M.S.
Provider Business Mailing Address
First Line : 1651 RESPONSE RD STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-5255
Country : US
Telephone Number : 916-518-3187
Fax Number :
Provider Business Practice Location Address
First Line : 1651 RESPONSE RD STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-5255
Country : US
Telephone Number : 916-518-3187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2019
Last Update Date : 05/31/2023

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