Individual
OLEG YURYEVICH SOROKOUMOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, SHARP GROSSMONT HOSPITAL, LA MESA, CA 91942
(858) 248-3634
Mailing address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(858) 248-3634
(858) 751-0588
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
48325
WI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
C55036
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306870548
—
CA
01
—
FY773
MEDICARE
CA
Enumeration date
07/11/2006
Last updated
12/10/2015
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