Healthcare Provider Details

I. General information

NPI: 1710406806
Provider Name (Legal Business Name): VINCENT FRANK SCALABRINO JR. IDC, PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS THUNDERBOLT
FPO AE
09588
US

IV. Provider business mailing address

USS THUNDERBOLT PC 12
APO AE
09588
US

V. Phone/Fax

Practice location:
  • Phone: 313-485-6209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM8033309
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: