Basic Information
| Provider Information | |||||||||
| NPI: | 1629116397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOBODOVA | ||||||||
| FirstName: | ADRIANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 732 SUMMITVIEW AVE # 621 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095733448 | ||||||||
| FaxNumber: | 5095744481 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 S 11TH AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095744433 | ||||||||
| FaxNumber: | 5095744432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 01/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | 11339 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | MD60250442 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | MD60250442 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 000097836 | 01 | MT | BCBS PIN | OTHER |