Provider Demographics
NPI:1265486880
Name:RIABOVA, KATERINA G (MD)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:G
Last Name:RIABOVA
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 1:2007 152ND AVE NE #13
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5521
Mailing Address - Country:US
Mailing Address - Phone:425-633-0119
Mailing Address - Fax:425-746-2308
Practice Address - Street 1:2007 152ND AVE NE #13
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5521
Practice Address - Country:US
Practice Address - Phone:425-633-0119
Practice Address - Fax:425-746-2308
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041397103T00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119734Medicaid
WAH88476Medicare UPIN
WAAB38327Medicare ID - Type UnspecifiedMEDICARE NUMBER