Provider Demographics
NPI:1932609906
Name:MIYABI ANESTHESIA ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MIYABI ANESTHESIA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:GHALAMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:777-443-4468
Mailing Address - Street 1:11625 CUSTER RD # 110-357
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8783
Mailing Address - Country:US
Mailing Address - Phone:972-420-0023
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:7000 PRESTON RD STE 1200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024
Practice Address - Country:US
Practice Address - Phone:972-420-0023
Practice Address - Fax:888-770-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty