Provider Demographics
NPI:1578565628
Name:YAHONTOVA, OLGA A (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:A
Last Name:YAHONTOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5808
Mailing Address - Country:US
Mailing Address - Phone:805-468-2188
Mailing Address - Fax:
Practice Address - Street 1:10333 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5808
Practice Address - Country:US
Practice Address - Phone:805-468-2000
Practice Address - Fax:805-468-6011
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-02-14
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2010-12-17
Provider Licenses
StateLicense IDTaxonomies
CA813372084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry