Individual
JENNIFER M MIRABAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 SARA RD SE, RR7 MAILSTOP 108, RIO RANCHO, NM 87124-1025
(505) 239-9644
Mailing address
4909 INDIGO DR NW, ALBUQUERQUE, NM 87120-4419
(505) 615-9824
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5462
NM
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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