Provider Demographics
NPI:1043796568
Name:GABOVA, YEKATERINA
Entity Type:Individual
Prefix:MISS
First Name:YEKATERINA
Middle Name:
Last Name:GABOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MYRTLE AVE OFC 204
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-7762
Mailing Address - Country:US
Mailing Address - Phone:203-717-2474
Mailing Address - Fax:
Practice Address - Street 1:250 MYRTLE AVE OFC 204
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-7762
Practice Address - Country:US
Practice Address - Phone:203-717-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator