Doctor Name: | ALFREDO MIRANDA |
NPI Number: | 1740571074 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 15818 Sw Warfield Blvd Indiantown, FL - 349563513 |
Business Phone Number: | 7725970411 |
Business Fax Number: | |
Mailing Address: | Po Box 458, INDIANTOWN |
State: | FL |
Postal Code: | 349560458 |
Phone Number: | 7723239249 |
Fax Number: | |
NPI Enumeration Date: | 04/20/2011 |
NPI Last Update Date: | 04/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |