1811003411 NPI number — EVAN MICHAEL VAPNEK M.D.

Table of content: EVAN MICHAEL VAPNEK M.D. (NPI 1811003411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811003411 NPI number — EVAN MICHAEL VAPNEK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAPNEK
Provider First Name:
EVAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811003411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33865
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92163-3865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-888-7700
Provider Business Mailing Address Fax Number:
858-500-8021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4033 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-0670
Provider Business Practice Location Address Fax Number:
858-429-7929
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  G75357 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0043510 . This is a "MEDICAID GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G753570 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WG75357E . This is a "PPIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AO536Y . This is a "MEDICARE PTAN-GHP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".