Provider Demographics
NPI:1225859770
Name:MIRELES, HUNTER MICKAL (HM)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:MICKAL
Last Name:MIRELES
Suffix:
Gender:M
Credentials:HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10360 BLUE GINGER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-4058
Mailing Address - Country:US
Mailing Address - Phone:702-684-1021
Mailing Address - Fax:
Practice Address - Street 1:10360 BLUE GINGER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-4058
Practice Address - Country:US
Practice Address - Phone:702-684-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner