Provider Demographics
NPI:1790725398
Name:GURVITS, VADIM (DO)
Entity Type:Individual
Prefix:DR
First Name:VADIM
Middle Name:
Last Name:GURVITS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-0966
Mailing Address - Country:US
Mailing Address - Phone:951-679-9700
Mailing Address - Fax:951-679-2219
Practice Address - Street 1:29798 HAUN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6541
Practice Address - Country:US
Practice Address - Phone:951-679-9700
Practice Address - Fax:951-672-0835
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG97086Medicare UPIN
CA4733970001Medicare NSC
CAZZZ25524ZMedicare PIN