Healthcare Provider Details

I. General information

NPI: 1295668150
Provider Name (Legal Business Name): VREIGE SARKIS GULGULIAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31946 MISSION TRAIL, SUITE B, LAKE ELSINORE, CA
LAKE ELSINORE CA
92530
US

IV. Provider business mailing address

39172 RIMROCK RANCH RD
TEMECULA CA
92591-7428
US

V. Phone/Fax

Practice location:
  • Phone: 951-245-7663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: