Provider Demographics
NPI:1396560322
Name:SONALAN, MIRASOL NIEVAS (CTRS)
Entity type:Individual
Prefix:
First Name:MIRASOL
Middle Name:NIEVAS
Last Name:SONALAN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 JACKRABBIT AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2071
Mailing Address - Country:US
Mailing Address - Phone:251-554-0199
Mailing Address - Fax:
Practice Address - Street 1:7405 JACKRABBIT AVE
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-2071
Practice Address - Country:US
Practice Address - Phone:251-554-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70490225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty