Provider Demographics
NPI:1578051066
Name:MIMBELA, GABRIELA (PMHNP)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:MIMBELA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 ZION LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3532
Mailing Address - Country:US
Mailing Address - Phone:915-637-7154
Mailing Address - Fax:
Practice Address - Street 1:9940 VISCOUNT BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-249-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775429163W00000X
TXAP146002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty