Provider Demographics
NPI:1730449745
Name:WARBURTON, MIRANDA (PHD, CMT)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:WARBURTON
Suffix:
Gender:F
Credentials:PHD, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SANTA CRUZ AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6830
Mailing Address - Country:US
Mailing Address - Phone:408-354-5588
Mailing Address - Fax:
Practice Address - Street 1:20 S SANTA CRUZ AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6830
Practice Address - Country:US
Practice Address - Phone:408-354-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33478171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor