Provider Demographics
NPI:1467230383
Name:MIAJI, SANAM
Entity Type:Individual
Prefix:
First Name:SANAM
Middle Name:
Last Name:MIAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 LA CASCADA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2929
Mailing Address - Country:US
Mailing Address - Phone:832-488-5942
Mailing Address - Fax:
Practice Address - Street 1:5901 W CENTURY BLVD STE 750
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5443
Practice Address - Country:US
Practice Address - Phone:888-880-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1137112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily