Individual
DANIEL BOONE MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1989 VICENTE DR, SAN LUIS OBISPO, CA 93405-6863
(805) 781-4179
Mailing address
1989 VICENTE DR, SAN LUIS OBISPO, CA 93405-6863
(805) 781-4179
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PT 36369
CA
167G00000X
Licensed Psychiatric Technician
Primary
36369
CA
Other
Enumeration date
05/29/2012
Last updated
01/24/2024
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