Healthcare Provider Details

I. General information

NPI: 1366093999
Provider Name (Legal Business Name): STEPHEN VANNUCCI DERMATOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 COHASSET RD
CHICO CA
95926-2241
US

IV. Provider business mailing address

251 COHASSET RD
CHICO CA
95926-2241
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-3686
  • Fax: 530-342-7285
Mailing address:
  • Phone: 530-342-3686
  • Fax: 530-342-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY-ANNE CLARKE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 530-342-3686