Provider Demographics
NPI:1730337296
Name:KATERINA G. RIABOVA, M.D. P.S.
Entity type:Organization
Organization Name:KATERINA G. RIABOVA, M.D. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIABOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-822-8153
Mailing Address - Street 1:2820 NORTHUP WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1438
Mailing Address - Country:US
Mailing Address - Phone:425-822-8153
Mailing Address - Fax:425-822-4010
Practice Address - Street 1:2820 NORTHUP WAY STE 105
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1438
Practice Address - Country:US
Practice Address - Phone:425-822-8153
Practice Address - Fax:425-822-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041397103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8803066Medicare PIN
WAH88476Medicare UPIN