Individual
MRS. VENERANDA MIRANDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
451 JEFFERSON AVE, CHARLES TOWN, WV 25414-1127
(951) 956-4261
Mailing address
451 JEFFERSON AVE, CHARLES TOWN, WV 25414-1127
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304000063391
UNITEDHEALTHCARE
WV
Enumeration date
08/20/2021
Last updated
08/20/2021
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