Provider Demographics
NPI:1174093587
Name:MIRANDA, VERONICA MARQUEZ
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:MARQUEZ
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:VERONICA
Other - Middle Name:M
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:539 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3419
Mailing Address - Country:US
Mailing Address - Phone:559-266-9581
Mailing Address - Fax:559-498-0507
Practice Address - Street 1:3636 N 1ST ST # 135&162
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-225-1464
Practice Address - Fax:844-601-2973
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)