Provider Demographics
NPI:1063523199
Name:MIRABELLI, RITA THERESA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:THERESA
Last Name:MIRABELLI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:119 WINNETKA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3613
Mailing Address - Country:US
Mailing Address - Phone:210-342-1733
Mailing Address - Fax:210-342-1733
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-949-3779
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX453299363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N105Medicare ID - Type Unspecified