Healthcare Provider Details

I. General information

NPI: 1558657031
Provider Name (Legal Business Name): TATYANA O YETTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TATYANA O BABINA MD

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number159905
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101252505
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: