Individual
DERIKK MIRABAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4801 MONTANO RD NW STE A2, ALBUQUERQUE, NM 87120-2423
(505) 336-0560
Mailing address
PO BOX 663, LAKELAND, MI 48143-0663
(734) 203-0181
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
02/14/2024
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