Provider Demographics
NPI:1457526105
Name:POGORELOV, VLADLEN (FNP)
Entity type:Individual
Prefix:MR
First Name:VLADLEN
Middle Name:
Last Name:POGORELOV
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 N STAR ST
Mailing Address - Street 2:NONE
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-1805
Mailing Address - Country:US
Mailing Address - Phone:415-407-1286
Mailing Address - Fax:
Practice Address - Street 1:4585 N STAR ST
Practice Address - Street 2:NONE
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-1805
Practice Address - Country:US
Practice Address - Phone:415-407-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2011-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily