Healthcare Provider Details

I. General information

NPI: 1255405783
Provider Name (Legal Business Name): STEPHEN ANTHONY VANNUCCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COHASSET RD SUITE 230
CHICO CA
95926-2241
US

IV. Provider business mailing address

1040 MANGROVE AVE
CHICO CA
95926-3509
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-3686
  • Fax: 530-342-4199
Mailing address:
  • Phone: 530-345-0064
  • Fax: 530-345-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA71303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: