Provider Demographics
NPI:1447354634
Name:MIRANDA, RAINIERO (MFT)
Entity type:Individual
Prefix:MR
First Name:RAINIERO
Middle Name:
Last Name:MIRANDA
Suffix:
Gender:
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CENTER BLVD # C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1764
Mailing Address - Country:US
Mailing Address - Phone:415-672-9367
Mailing Address - Fax:
Practice Address - Street 1:753 CENTER BLVD # C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1764
Practice Address - Country:US
Practice Address - Phone:415-672-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36303101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health