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General NPI Number Information
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NPI Number | 1386800365
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Entity Type | Organization
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Legal Business Name | MIRA VISTA ENTERPRISE, INC.
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 01/08/2017
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Provider Practice Location Address
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Address Line | 12500 BELLA VINO DR
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City | FORT WORTH
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State | TX
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Zip | 76126-4930
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Country | US
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Telephone | 817-819-2349
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Fax |
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Provider Business Mailing Address
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Address Line | 12500 BELLA VINO DR
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City | FORT WORTH
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State | TX
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Zip | 76126-4930
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Country | US
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Telephone | 817-819-2349
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEJANDRO NOBLEJAS FLORES
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Credential |
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Telephone | 817-819-2349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | TX
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