Healthcare Provider Details

I. General information

NPI: 1619141710
Provider Name (Legal Business Name): VLADIMIR BULANIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CAMPUS COMMONS RD SUITE 120
SACRAMENTO CA
95825-8309
US

IV. Provider business mailing address

777 CAMPUS COMMONS RD SUITE 120
SACRAMENTO CA
95825-8309
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax:
Mailing address:
  • Phone: 916-929-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: