Provider Demographics
NPI:1952304545
Name:YABRAIAN, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:YABRAIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-0580
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:972-991-9548
Practice Address - Street 1:5920 FOREST PARK RD
Practice Address - Street 2:STE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6416
Practice Address - Country:US
Practice Address - Phone:214-902-1440
Practice Address - Fax:214-902-1593
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034587801Medicaid
TX00L438Medicare ID - Type Unspecified
TX034587801Medicaid