Individual
GREGORY AVETISOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2641 MILLER RUN LN, LINCOLN, CA 95648-7545
(209) 754-6262
Mailing address
PO BOX 939, ANGELS CAMP, CA 95222-0939
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20A22510
CA
208D00000X
General Practice Physician
Primary
20A22510
CA
208D00000X
General Practice Physician
OS17139
FL
Other
Enumeration date
04/25/2013
Last updated
01/28/2026
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