Provider Demographics
NPI:1528298783
Name:MIRABELLA, TINA W (LVN)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:W
Last Name:MIRABELLA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 VIA DEL ASTRO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7339
Mailing Address - Country:US
Mailing Address - Phone:760-583-8829
Mailing Address - Fax:
Practice Address - Street 1:338 VIA DEL ASTRO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7339
Practice Address - Country:US
Practice Address - Phone:760-583-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN108024164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse