Individual
JESNY LICETH MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1390 GEORGE DIETER DR STE 140, EL PASO, TX 79936-7430
(915) 320-1390
Mailing address
14708 HARRY FLOURNOY AVE, EL PASO, TX 79938-1030
(915) 346-9100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
104143
TX
Other
Enumeration date
12/28/2021
Last updated
12/28/2021
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