Provider Demographics
NPI:1619141710
Name:BULANIN, VLADIMIR (NP)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:BULANIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CAMPUS COMMONS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8309
Mailing Address - Country:US
Mailing Address - Phone:916-929-8564
Mailing Address - Fax:
Practice Address - Street 1:777 CAMPUS COMMONS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8309
Practice Address - Country:US
Practice Address - Phone:916-929-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18063OtherNURSE PRACTICIONER
P00674790OtherRAILROAD MEDICARE