Healthcare Provider Details

I. General information

NPI: 1154856631
Provider Name (Legal Business Name): STAN POGREBINSKY I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 VIA FRANCESCO UNIT 3
SAN DIEGO CA
92129-5149
US

IV. Provider business mailing address

7750 VIA FRANCESCO UNIT 3
SAN DIEGO CA
92129-5149
US

V. Phone/Fax

Practice location:
  • Phone: 858-449-5445
  • Fax:
Mailing address:
  • Phone: 858-449-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number72019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: