Individual
MIRANDA SUSIE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4612 ROOSEVELT AVE, SACRAMENTO, CA 95820-4520
(916) 379-5876
Mailing address
18225 HALE AVE, MORGAN HILL, CA 95037-3547
(916) 892-6024
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41809
CA
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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