Provider Demographics
NPI:1417235532
Name:ON DEMAND PRIMARY CARE & NURSING, INC
Entity Type:Organization
Organization Name:ON DEMAND PRIMARY CARE & NURSING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADLEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:POGORELOV
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:415-407-1286
Mailing Address - Street 1:4585 NORTHSTAR STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677
Mailing Address - Country:US
Mailing Address - Phone:415-407-1286
Mailing Address - Fax:916-348-9545
Practice Address - Street 1:4585 NORTHSTAR STREET
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:415-407-1286
Practice Address - Fax:916-348-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17441363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty