PRISTINE SURGICAL INCORPORATED (NPI# 1336648500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336648500 |
| Entity Type | Organization |
| Organization Name | PRISTINE SURGICAL INCORPORATED |
| Practice Address |
6699 Alvarado Rd Ste 2309 San Diego CA 92120-5241 |
| Mailing Address |
7905 Tommy Dr San Diego CA 92119-1833 |
| Practice Telephone | 6193966637 |
| Practice Fax Number | 6198253406 |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2020-03-10 |
| Authorized Official Name | VADIM AVULOV (PRESIDENT) |
| Authorized Official Telephone | 9176024507 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 20A13344 | CA | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6699 Alvarado Rd Ste 2309, San Diego, CA 921205241 | 6193966637 | 6198253406 |
| Street Address |
6699 ALVARADO RD STE 2309 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92120-5241 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700121472 | Vadim Avulov | Surgery | 6699 Alvarado Rd Ste 2309, San Diego, CA 92120-5241 | 2012-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316550510 | Jessica Elizabeth Knight | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Ct, 310, San Diego, CA 92120 | 2020-08-26 |
| 1770195091 | Julia Roccanova | Student in an Organized Health Care Education/Training Program | 6383 Alvarado Court, Suite 310, San Diego, CA 92120 | 2020-08-18 |
| 1225593601 | Truself Training, Inc | Clinic/Center | 5125 Waring Road, San Diego, CA 92120 | 2019-02-09 |
| 1508381799 | Antin Sachs | In Home Supportive Care | 4420 Rainier Avenue, Suite 202, San Diego, CA 92120 | 2017-08-08 |
| 1588186415 | Matthew B Wilbat | Behavioral Analyst | 6851 Alvarado Rd., #17, San Diego, CA 92120 | 2017-07-12 |
| 1548782923 | Mori Khatibzadeh Dds Inc. | Clinic/Center | 6171 Mission Gorge Road, Suite #114, San Diego, CA 92120 | 2017-07-07 |
| 1306379359 | Ken Samith Oerding | Nurse Practitioner | 5422 Reservoir Drive, E7, San Diego Ca, CA 92120 | 2017-04-06 |
| 1396134409 | Debra Michele Stern-ellis | Social Worker | 4647 Zion Avenue Kaiser Permanente, 2nd Floor - Oncology, San Diego, CA 92120 | 2015-01-13 |
| 1821494717 | Shohreh Tourian | Dentist | 7451 Mission Gorge Road, San Diego, CA 92120 | 2014-11-05 |
| 1184049215 | Charles Yin | Counselor | 6153 Fairmount Ave Suite #260, San Diego, CA 92120 | 2014-02-26 |
| Find all providers in zip 92120 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295361772 | William Robert Berry | Surgery | 5775 Del Cerro Blvd, San Diego, CA 92120-4513 | 2020-03-17 |
| 1376185116 | Charles Theuer | Surgery | 4350 La Jolla Village Dr Ste 800, San Diego, CA 92122-1247 | 2019-10-14 |
| 1538656202 | Stewart Reese Logan | Surgery | 200 W Arbor Dr # Mc7220, San Diego, CA 92103-1911 | 2018-04-18 |
| 1447773114 | R R Gohil Md Apc | Surgery | 6386 Alvarado Ct Ste 330, San Diego, CA 92120-4908 | 2017-07-25 |
| 1720475148 | Advanced Wound Care, Inc | Surgery | 5124 Bloch St, San Diego, CA 92122-4005 | 2015-04-23 |
| 1841532843 | San Diego Emergency Physician Services, Inc. | Surgery | 6487 Dwane Ave, San Diego, CA 92120-3924 | 2013-03-18 |
| 1336488485 | Victor Herbert Lidner | Surgery | 809 Deal Ct, San Diego, CA 92109-8131 | 2013-02-10 |
| 1588909097 | San Diego Advanced Surgery P.C. | Surgery | 3245 University Ave # 501, San Diego, CA 92104-2009 | 2012-12-10 |
| 1700121472 | Vadim Avulov | Surgery | 6699 Alvarado Rd Ste 2309, San Diego, CA 92120-5241 | 2012-12-06 |
| 1194075861 | Rachel Kaye Voss | Surgery | 3146 Cowley Way, Apt 4, San Diego, CA 92117-6519 | 2012-09-10 |
| Find all providers in SAN DIEGO | ||||
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| 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.