Provider Demographics
NPI:1619772613
Name:URBAN, MIRANDA LEIGH
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:LEIGH
Last Name:URBAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEIGH
Other - Last Name:ILIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1817 W AVENUE K
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-6421
Mailing Address - Country:US
Mailing Address - Phone:219-797-2913
Mailing Address - Fax:
Practice Address - Street 1:1817 W AVENUE K
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6421
Practice Address - Country:US
Practice Address - Phone:219-797-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator