Provider Demographics
NPI:1023635562
Name:GRISTAN, YANA DAVIDOVNA (MD)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:DAVIDOVNA
Last Name:GRISTAN
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:SANTA BARBARA COTTAGE HOSPITAL - MEDICAL EDUCATION
Mailing Address - Street 2:400 W PUEBLO STREET
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-569-7315
Mailing Address - Fax:805-569-8358
Practice Address - Street 1:SANTA BARBARA COTTAGE HOSPITAL
Practice Address - Street 2:400 WEST PUEBLO ST
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4353
Practice Address - Country:US
Practice Address - Phone:805-682-7111
Practice Address - Fax:805-569-8358
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA186841207R00000X
CAPTL-5361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine