Provider Demographics
NPI:1609908763
Name:MIRA CONSULTING, INCORPORATED
Entity Type:Organization
Organization Name:MIRA CONSULTING, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-898-2797
Mailing Address - Street 1:4100 HAWKINS ST NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4531
Mailing Address - Country:US
Mailing Address - Phone:505-898-2797
Mailing Address - Fax:
Practice Address - Street 1:4100 HAWKINS ST NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4531
Practice Address - Country:US
Practice Address - Phone:505-898-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Not Answered251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS2785Medicaid