Basic Information
| Provider Information | |||||||||
| NPI: | 1366093999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHEN VANNUCCI DERMATOLOGY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 COHASSET RD | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303423686 | ||||||||
| FaxNumber: | 5303427285 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 COHASSET RD | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303423686 | ||||||||
| FaxNumber: | 5303427285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2019 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | CLARKE | ||||||||
| AuthorizedOfficialFirstName: | MARY-ANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5303423686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207N00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.