Provider Demographics
NPI:1407090178
Name:PIKAREVICH, VITALY
Entity Type:Individual
Prefix:MR
First Name:VITALY
Middle Name:
Last Name:PIKAREVICH
Suffix:
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 1:501 TARAVAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2511
Mailing Address - Country:US
Mailing Address - Phone:415-706-4081
Mailing Address - Fax:415-242-3251
Practice Address - Street 1:1801 23RD AVE
Practice Address - Street 2:SUITE 27
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4452
Practice Address - Country:US
Practice Address - Phone:415-706-4081
Practice Address - Fax:415-242-3251
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2009-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372401343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)