Individual
MARY V MIRTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2608 BROCKTON DR, AUSTIN, TX 78758-4414
(512) 654-4050
(512) 654-4051
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L1674
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153610401
—
TX
Enumeration date
08/11/2006
Last updated
01/25/2022
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