Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 36-617 | MS |
Y | 103TC0700X | Clinical Psychologist | 36-617 | MS |
NPI | 1003924036 |
---|---|
Provider Name | Dr. Robert F Mirabella |
First Address | Las Vegas, NV 89123 |
Second Address | Las Vegas, NV 89106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 12/07/2007 |