Provider Demographics
NPI:1093440703
Name:ALEXANDRU, MIRABELLA
Entity Type:Individual
Prefix:PROF
First Name:MIRABELLA
Middle Name:
Last Name:ALEXANDRU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 W WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2034
Mailing Address - Country:US
Mailing Address - Phone:602-907-1635
Mailing Address - Fax:623-440-3322
Practice Address - Street 1:14611 W WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2034
Practice Address - Country:US
Practice Address - Phone:602-907-1635
Practice Address - Fax:623-440-3322
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAL12224H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility