Healthcare Provider Details

I. General information

NPI: 1306251079
Provider Name (Legal Business Name): EKATERINA YAVAROVICH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 600
HOUSTON TX
77030-5206
US

IV. Provider business mailing address

6410 FANNIN ST STE 600
HOUSTON TX
77030-5206
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7000
  • Fax:
Mailing address:
  • Phone: 832-325-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number277130
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberW0002
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberW0002
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number259788
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number277130
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: