Healthcare Provider Details

I. General information

NPI: 1609908763
Provider Name (Legal Business Name): MIRA CONSULTING, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HAWKINS ST NE STE A
ALBUQUERQUE NM
87109-4531
US

IV. Provider business mailing address

4100 HAWKINS ST NE STE A
ALBUQUERQUE NM
87109-4531
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-2797
  • Fax:
Mailing address:
  • Phone: 505-898-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL E. MIRABAL
Title or Position: CEO
Credential:
Phone: 505-898-2797