Provider Demographics
NPI:1902289440
Name:KHODAKIVSKA, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KHODAKIVSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7303
Mailing Address - Country:US
Mailing Address - Phone:760-773-4560
Mailing Address - Fax:760-773-4561
Practice Address - Street 1:415 S PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7303
Practice Address - Country:US
Practice Address - Phone:760-773-4560
Practice Address - Fax:760-773-4561
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1675212084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty