Provider Demographics
NPI:1811003411
Name:VAPNEK, EVAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MICHAEL
Last Name:VAPNEK
Suffix:
Gender:M
Credentials:MD
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 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-500-8021
Practice Address - Street 1:4033 3RD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2117
Practice Address - Country:US
Practice Address - Phone:619-299-0670
Practice Address - Fax:858-429-7929
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75357208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0043510OtherMEDICAID GROUP #
CA00G753570Medicaid
CAWG75357EOtherPPIN
CAAO536YOtherMEDICARE PTAN-GHP
CAAO536YOtherMEDICARE PTAN-GHP
CAG73059Medicare UPIN