Healthcare Provider Details

I. General information

NPI: 1053844696
Provider Name (Legal Business Name): NATHALIE MIRABENT-ALVAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATHALIE M MIRABENT GARCIA MD

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

V. Phone/Fax

Practice location:
  • Phone: 786-862-1779
  • Fax:
Mailing address:
  • Phone: 561-955-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME174411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: