Provider Demographics
NPI:1457740441
Name:YAMBULATOVA, DINARA (MPAS, PA)
Entity type:Individual
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First Name:DINARA
Middle Name:
Last Name:YAMBULATOVA
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Gender:
Credentials:MPAS, PA
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Mailing Address - Street 1:6849 OLD DOMINION DR STE 315
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3733
Mailing Address - Country:US
Mailing Address - Phone:571-378-1398
Mailing Address - Fax:571-580-0620
Practice Address - Street 1:6849 OLD DOMINION DR STE 315
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3733
Practice Address - Country:US
Practice Address - Phone:571-378-1398
Practice Address - Fax:571-580-0620
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2025-02-19
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Provider Licenses
StateLicense IDTaxonomies
VA0110004891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant