Basic Information
| Provider Information | |||||||||
| NPI: | 1942547294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY STE 325 | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493646000 | ||||||||
| FaxNumber: | 9493649561 | ||||||||
| Practice Location | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY STE 325 | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493646000 | ||||||||
| FaxNumber: | 9493649561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2013 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 713758 | CA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F0812375 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 713758 | 01 | CA | RN LIC # | OTHER | F0812375 | 01 | CA | FNP PROV LIC # | OTHER |