Individual
MIRABELLA MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2700 BOLDT ST, LAS CRUCES, NM 88005-3876
(575) 640-2758
Mailing address
2700 BOLDT ST, LAS CRUCES, NM 88005-3876
(575) 640-2758
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1324
NM
Other
Enumeration date
01/02/2021
Last updated
01/02/2021
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