Healthcare Provider Details

I. General information

NPI: 1083740542
Provider Name (Legal Business Name): ZHANNA BYALAYA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 W LAS POSITAS BLVD SUITE 200
PLEASANTON CA
94588-4054
US

IV. Provider business mailing address

5725 W LAS POSITAS BLVD SUITE 200
PLEASANTON CA
94588-4054
US

V. Phone/Fax

Practice location:
  • Phone: 925-469-6274
  • Fax: 925-924-1769
Mailing address:
  • Phone: 925-469-6274
  • Fax: 925-924-1769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: