Individual
RIA MIRABUENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2942 BREA BLVD, FULLERTON, CA 92835-2015
(120) 241-3807
Mailing address
2942 BREA BLVD, FULLERTON, CA 92835-2015
(120) 241-3807
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA109005
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F7345675
—
CA
Enumeration date
02/03/2023
Last updated
02/03/2023
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