Provider Demographics
NPI:1801319884
Name:HELLMAN, GINA VLADIMIROVA (OD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:VLADIMIROVA
Last Name:HELLMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GERGANA
Other - Middle Name:VLADIMIROVA
Other - Last Name:GRIGOROVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5141 V ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:805 AEROVISTA PL STE 109
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7970
Practice Address - Country:US
Practice Address - Phone:805-439-1010
Practice Address - Fax:805-439-1213
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33718TLG152W00000X
CAOPT33718TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist