Provider Demographics
NPI:1629116397
Name:SLOBODOVA, ADRIANA (MD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:SLOBODOVA
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 1:732 SUMMITVIEW AVE # 621
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3032
Mailing Address - Country:US
Mailing Address - Phone:509-573-3448
Mailing Address - Fax:509-574-4481
Practice Address - Street 1:111 S 11TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3242
Practice Address - Country:US
Practice Address - Phone:509-574-4433
Practice Address - Fax:509-574-4432
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11339207RC0001X
WAMD60250442207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000097836OtherBCBS PIN
MT011000454Medicare PIN
MT000097836OtherBCBS PIN
WYW21666Medicare PIN