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General NPI Number Information
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NPI Number | 1649919622
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Entity Type | Individual
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Provider Name | JONATHAN MIRELES MSOT
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Gender | Male
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 508 W GRIFFIN PKWY STE A
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City | MISSION
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State | TX
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Zip | 78572-2224
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Country | US
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Telephone | 956-583-1527
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Fax |
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Provider Business Mailing Address
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Address Line | 418 CHEROKEE LN
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City | ALAMO
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State | TX
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Zip | 78516-6875
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Country | US
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Telephone | 956-599-2647
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 122724
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License Number State | TX
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