Provider Demographics
NPI:1609501022
Name:POHANKOVA, JAROSLAVA (PMHNP-BC, MSN, RN-BC)
Entity Type:Individual
Prefix:
First Name:JAROSLAVA
Middle Name:
Last Name:POHANKOVA
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 CHESEBRO RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2272
Mailing Address - Country:US
Mailing Address - Phone:310-866-2663
Mailing Address - Fax:
Practice Address - Street 1:5012 CHESEBRO RD STE 200
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2287
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021668363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty