Provider Demographics
NPI:1629021365
Name:BOKARIUS, VLADIMIR (MD, PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:BOKARIUS
Suffix:
Gender:M
Credentials:MD, PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 HILLTOP MALL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1948
Mailing Address - Country:US
Mailing Address - Phone:510-323-2524
Mailing Address - Fax:510-323-2524
Practice Address - Street 1:3260 BLUME DR STE 450
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5203
Practice Address - Country:US
Practice Address - Phone:415-787-4667
Practice Address - Fax:415-787-4667
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA845592084P0800X, 2084P0805X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK860AOtherPTAN
CAA84559Medicare ID - Type Unspecified