Provider Demographics
NPI:1891487708
Name:YASONOVA, MIA
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:
Last Name:YASONOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIUBOV
Other - Middle Name:
Other - Last Name:BALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-2201
Mailing Address - Fax:661-326-2950
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-326-2201
Practice Address - Fax:661-326-2950
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program