Provider Demographics
NPI:1356586937
Name:PABLANI, LATA
Entity type:Individual
Prefix:
First Name:LATA
Middle Name:
Last Name:PABLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATA
Other - Middle Name:
Other - Last Name:PABLANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14111 KING RD STE 320
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-8981
Mailing Address - Country:US
Mailing Address - Phone:718-879-0325
Mailing Address - Fax:
Practice Address - Street 1:14111 KING RD STE 320
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-8981
Practice Address - Country:US
Practice Address - Phone:469-888-4890
Practice Address - Fax:866-292-0929
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273214DP207R00000X
390200000X
TXR5176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty