OLEG YURYEVICH SOROKOUMOV (NPI# 1306870548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306870548 |
| Entity Type | Individual |
| Full Name | OLEG YURYEVICH SOROKOUMOV |
| Credential | MD |
| Practice Address |
5555 Grossmont Center Dr Sharp Grossmont Hospital La Mesa CA 91942 |
| Mailing Address |
5555 Grossmont Center Dr La Mesa CA 91942-3019 |
| Practice Telephone | 8582483634 |
| Mailing Telephone | 8582483634 |
| Mailing Fax Number | 8587510588 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-12-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
C55036 | CA | Allopathic & Osteopathic Physicians |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
48325 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1306870548 | 05 | |
| CA | MEDICARE | FY773 | 01 |
| Street Address |
5555 GROSSMONT CENTER DR SHARP GROSSMONT HOSPITAL |
| City | LA MESA |
| State | CA |
| Zip Code | 91942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770589293 | Raed A Al-naser | Internal Medicine | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2005-06-21 |
| 1568062552 | Justin Cantley | Nurse Practitioner | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2020-10-28 |
| 1942828314 | Honey Mae Cosare Surmillon | Licensed Vocational Nurse | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2020-07-11 |
| 1922632801 | Susan Daniels | Occupational Therapist | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2020-02-28 |
| 1457917791 | Elpitha K Tsiskakis | Physician Assistant | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2019-05-13 |
| 1336601053 | Diane Wade Bloomberg | Dietitian, Registered | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2019-04-02 |
| 1265992846 | Vincent Crump | Registered Nurse | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2019-03-21 |
| 1295210029 | United Urology Consultants, P.C. | Urology | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2018-09-27 |
| 1639660368 | Aileen Cathy Chu | Pharmacist | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2018-05-29 |
| 1447767678 | Leslie Ling | Registered Nurse | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2018-01-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902453723 | Nicole V Zappelli | Case Manager/Care Coordinator | 4990 William Ave., La Mesa, CA 91942 | 2019-08-26 |
| 1770059834 | Natalie Ngoc Nguyen | Physician Assistant | 5555 Grosmont Center Dr., La Mesa, CA 91942 | 2018-10-16 |
| 1194204297 | Courtney Pietsch | Nurse Practitioner | 8851 Health Center Circle, Suite #603, La Mesa, CA 91942 | 2018-08-09 |
| 1295214773 | Megan Gordon | Behavior Technician | 6116 Horton Dr, La Mesa, CA 91942 | 2018-08-07 |
| 1356836548 | Kimberly Denise Davis | Counselor | 3845 Avocado School Road, El Cajon, CA 91942 | 2018-06-29 |
| 1366932113 | Melanie Joyce Shepard | Physician Assistant | 7051 Alvarado Road, Suite 201, La Mesa, CA 91942 | 2018-05-17 |
| 1871013532 | Low Dental, A.p.c. | Public Health or Welfare | 7872 La Mesa Blvd., La Mesa, CA 91942 | 2017-06-23 |
| 1275069437 | Ardel Ayala | Respiratory Therapist, Registered | 5800 Lake Murray Blvd. Unit 15, La Mesa, CA 91942 | 2017-05-10 |
| 1285007583 | Counseling & Behavioral Specialists | Marriage & Family Therapist | 5520 Wellesley Street, Ste 204, La Mesa, CA 91942 | 2015-11-09 |
| 1285001875 | Emily Shozaki Rizo | Nurse Practitioner | 6285 Meadowcrest Drive, La Mesa, CA 91942 | 2015-08-31 |
| Find all providers in zip 91942 | ||||
| Taxonomy Code | 207RC0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Critical Care Medicine |
| An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427502079 | Mandegar Medical Corp | Internal Medicine | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2016-08-12 |
| 1851500805 | Mandegar Medical Corp | Internal Medicine | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2007-05-22 |
| 1174689335 | Mehran Mandegar | Internal Medicine | 5555 Grossmont Center Dr, La Mesa, CA 91942-3019 | 2006-12-29 |
| 1174542252 | Kaveh Bagheri | Internal Medicine | 8860 Center Drive, Suite 240, La Mesa, CA 91942-7000 | 2006-07-19 |
| 1801865498 | Larry Newell Ayers | Internal Medicine | 5565 Grossmont Center Dr, Ste 360, La Mesa, CA 91942-3020 | 2006-03-16 |
| 1083683635 | David Frederick Polster | Internal Medicine | 5565 Grossmont Center Dr, Ste 360, La Mesa, CA 91942-3020 | 2006-03-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245082 | Oc Pulmonary & Sleep, Inc | Internal Medicine | 14642 Newport Ave #101, Irvine, CA 92780-6058 | 2020-11-08 |
| 1295332633 | Compassionate Critical Care Group, Inc. | Internal Medicine | 22543 Ventura Blvd Ste 220, Woodland Hills, CA 91364-1403 | 2020-10-08 |
| 1972149748 | Bay Area Neurointensivists Inc | Internal Medicine | 3066 Deer Meadow Dr, Danville, CA 94506-2135 | 2019-11-26 |
| 1356903298 | Benjamin R Deaton Md Inc. | Internal Medicine | 7468 Muirwood Ct, Pleasanton, CA 94588-4232 | 2019-07-01 |
| 1851950232 | Riverside Medical Clinic Inc | Internal Medicine | 4100 Central Ave Ste 201, Riverside, CA 92506-2930 | 2019-06-10 |
| 1407414329 | Riverside Medical Clinic Inc | Internal Medicine | 2079 Compton Ave Ste A101, Corona, CA 92881-7284 | 2019-06-05 |
| 1144718875 | Jeffrey Tobias | Internal Medicine | 10 Lavender Ter, Petaluma, CA 94952-4938 | 2018-04-27 |
| 1780187229 | Jesse Robles | Internal Medicine | 651 Sunnyside Ave, San Diego, CA 92114-4945 | 2018-03-12 |
| 1710403183 | Excelcare | Internal Medicine | 2400 Chester Ave, Bakersfield, CA 93301-4020 | 2017-08-17 |
| 1255865549 | Liou Medical Inc | Internal Medicine | 17310 Evening Star Ave, Cerritos, CA 90703-8318 | 2017-04-13 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on OLEG YURYEVICH SOROKOUMOV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.