Physician Compare National (NPI:1700121472)

HEALTHCARE PROVIDER: VADIM AVULOV D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700121472
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577703834
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150122002289
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AVULOV
	Individual professional last name
Provider First Name	VADIM
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	7905 TOMMY DR
	Group Practice or individual's line 1 address
City	SAN DIEGO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	921191833
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GROSSMONT HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050757
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALVARADO HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050234
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SHARP CORONADO HOSPITAL AND HLTHCR CTR
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y