Provider Demographics
NPI:1972695252
Name:VINOGRADOVA, HELEN LEO (MD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:LEO
Last Name:VINOGRADOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOROTKOVA
Other - Middle Name:ELENA
Other - Last Name:LEONIDOVNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:877-860-2397
Practice Address - Street 1:7215 55TH STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2601
Practice Address - Country:US
Practice Address - Phone:916-399-1100
Practice Address - Fax:877-860-2397
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01783727-DV5277OtherRAILROAD MEDICARE
CACA234729-CA140503Medicare UPIN
CAP01783727-DV5277OtherRAILROAD MEDICARE