Provider Demographics
NPI:1124814900
Name:BALESTRAZZI MIRABAL, ANA SOPHIA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:SOPHIA
Last Name:BALESTRAZZI MIRABAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2997 CROSBY BLVD SW APT 332
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7842
Mailing Address - Country:US
Mailing Address - Phone:786-381-8124
Mailing Address - Fax:
Practice Address - Street 1:2997 CROSBY BLVD SW APT 332
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7842
Practice Address - Country:US
Practice Address - Phone:786-381-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter