Healthcare Provider Details

I. General information

NPI: 1194833277
Provider Name (Legal Business Name): CHRISTINE MIYAKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD STE 203
LAS VEGAS NV
89107-1084
US

IV. Provider business mailing address

500 N RAINBOW BLVD STE 203
LAS VEGAS NV
89107-1084
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1228
  • Fax: 402-559-9659
Mailing address:
  • Phone: 702-259-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37706
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number242918
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26129
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15306
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: