Provider Demographics
NPI:1548383052
Name:MIRABAL RESTAURANT PROPERTIES
Entity Type:Organization
Organization Name:MIRABAL RESTAURANT PROPERTIES
Other - Org Name:ARLINGTON MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-472-5555
Mailing Address - Street 1:3330 MATLOCK RD
Mailing Address - Street 2:110
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2917
Mailing Address - Country:US
Mailing Address - Phone:817-472-5555
Mailing Address - Fax:817-465-5540
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:110
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2917
Practice Address - Country:US
Practice Address - Phone:817-472-5555
Practice Address - Fax:817-465-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326460001Medicare ID - Type Unspecified