Individual
TINA MARIE MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4912 PALMER AVE, STOCKTON, CA 95215-1825
(209) 480-1293
Mailing address
4912 PALMER AVE, STOCKTON, CA 95215-1825
(209) 480-1293
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
250132475
CA
Other
Enumeration date
04/23/2026
Last updated
04/23/2026
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