Healthcare Provider Details

I. General information

NPI: 1891582474
Provider Name (Legal Business Name): DANIEL E MIRABAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NW 107TH AVE STE 110
MIAMI FL
33172-3100
US

IV. Provider business mailing address

11042 NW 59TH PL
HIALEAH FL
33012-6511
US

V. Phone/Fax

Practice location:
  • Phone: 305-964-5426
  • Fax:
Mailing address:
  • Phone: 786-663-1165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: