Provider Demographics
NPI:1598273807
Name:BOGDANOV, ANDREY
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:BOGDANOV
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 1:5302 NE 72ND AVE APT I93
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3572
Mailing Address - Country:US
Mailing Address - Phone:360-450-7786
Mailing Address - Fax:
Practice Address - Street 1:4440 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7825
Practice Address - Country:US
Practice Address - Phone:702-867-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker