Pristine Surgical Incorporated

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

20A13344 Issued in CA

Legal business name

PRISTINE SURGICAL INCORPORATED

Practice address

6699 Alvarado Rd Ste 2309
San Diego, CA 92120-5241

Phone

(619) 396-6637

Fax

(619) 825-3406

NPI assigned

Feb 2, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vadim Avulov, DONPI 1700121472

Title

President

Phone

(917) 602-4507

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vadim Avulov, D.O.

  • Surgery Physician
  • San Diego, CA
  • NPI 1700121472
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1336648500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7905 TOMMY DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921191833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD STE 2309",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205241",
            "telephone_number": "619-396-6637",
            "fax_number": "619-825-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE SURGICAL INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-02",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "AVULOV",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-602-4507",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "20A13344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lincoln Gage Prior
• Priscilla Jouvin Psychotherapy
• Lauren Prisco
• Taylor Leigh Priselac, DACM, LAC, DIPL. OM
• Pristine Dental, Vu Thanh Thai, DMD Inc.
• Taylor Lyn Pritchard, FNP
• Michael Pritsker, D.C., Q.M.E.
• Private Healthcare Facilities
• Private Healthcare Facilities
• David Michael Priver, MD

• Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.