Healthcare Provider Details

I. General information

NPI: 1396408092
Provider Name (Legal Business Name): GABRIELA O MIRO ROS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E MAGNOLIA DR
BELGRADE MT
59714-9264
US

IV. Provider business mailing address

42 E MAGNOLIA DR
BELGRADE MT
59714-9264
US

V. Phone/Fax

Practice location:
  • Phone: 787-536-7353
  • Fax:
Mailing address:
  • Phone: 787-536-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberAHC-NAT-LIC-2335
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: