1629116397 NPI number — ADRIANA SLOBODOVA MD

Table of content: ADRIANA SLOBODOVA MD (NPI 1629116397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629116397 NPI number — ADRIANA SLOBODOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOBODOVA
Provider First Name:
ADRIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629116397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 SUMMITVIEW AVE # 621
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-3032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-573-3448
Provider Business Mailing Address Fax Number:
509-574-4481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 S 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-4433
Provider Business Practice Location Address Fax Number:
509-574-4432
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X , with the licence number:  11339 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MD60250442 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: MD60250442 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000097836 . This is a "BCBS PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com