Healthcare Provider Details

I. General information

NPI: 1356732259
Provider Name (Legal Business Name): MIRABEL ALUMBA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

IV. Provider business mailing address

7001 IRONBRIDGE LN
LAUREL MD
20707-9483
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1817
  • Fax:
Mailing address:
  • Phone: 301-442-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1008468
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: