Individual
KENNETH MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
375 WOODSIDE AVE, BLDG W-3, SAN FRANCISCO, CA 94127-1221
(415) 753-4443
Mailing address
375 WOODSIDE AVE, BLDG W-3, SAN FRANCISCO, CA 94127-1221
(415) 753-4443
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
12479
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
486
CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
—
Enumeration date
03/28/2007
Last updated
07/16/2007
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