Healthcare Provider Details

I. General information

NPI: 1164288502
Provider Name (Legal Business Name): MIRAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 CHERRY LANE CT STE 108
LAUREL MD
20707-4978
US

IV. Provider business mailing address

14300 CHERRY LANE CT STE 108
LAUREL MD
20707-4978
US

V. Phone/Fax

Practice location:
  • Phone: 832-441-4736
  • Fax:
Mailing address:
  • Phone: 443-924-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHIOMA SNOWBIRD IROEGBU
Title or Position: OWNER
Credential: NP
Phone: 832-441-4736