Provider Demographics
NPI:1154856631
Name:POGREBINSKY, STAN I
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:POGREBINSKY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 VIA FRANCESCO UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5149
Mailing Address - Country:US
Mailing Address - Phone:858-449-5445
Mailing Address - Fax:
Practice Address - Street 1:7750 VIA FRANCESCO UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-5149
Practice Address - Country:US
Practice Address - Phone:858-449-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72019172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker