Individual
GUSTAVO ALBERTO MIRABAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MEDICAL STUDENT MS4
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-2407
Mailing address
CALLE PRINCIPE 641, EXT. EL COMANDANTE, CAROLINA, PR 00982
(939) 249-7814
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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