Provider Demographics
NPI:1437342086
Name:MIRBAHA, LEYLA
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:MIRBAHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEYLA
Other - Middle Name:
Other - Last Name:MIRBAHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3270 PARAGON PL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4220
Mailing Address - Country:US
Mailing Address - Phone:408-910-8424
Mailing Address - Fax:
Practice Address - Street 1:10685 PROFESSIONAL CIRCLE, SUITE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-322-1000
Practice Address - Fax:775-322-1050
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13322152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist