Provider Demographics
NPI:1700911419
Name:MIRANDA, CANDICE MARIE (AA)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3611 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6928
Mailing Address - Country:US
Mailing Address - Phone:714-966-8680
Mailing Address - Fax:
Practice Address - Street 1:3611 S HARBOR
Practice Address - Street 2:SUITE100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6823
Practice Address - Country:US
Practice Address - Phone:714-966-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor