Organization
PRISTINE SURGICAL INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VADIM AVULOV DO (PRESIDENT)
(917) 602-4507
Entity
Organization
Contact information
Practice address
6699 ALVARADO RD STE 2309, SAN DIEGO, CA 92120-5241
(619) 396-6637
(619) 825-3406
Mailing address
7905 TOMMY DR, SAN DIEGO, CA 92119-1833
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20A13344
CA
Other
Enumeration date
02/02/2018
Last updated
03/10/2020
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