Healthcare Provider Details

I. General information

NPI: 1770652141
Provider Name (Legal Business Name): JOSEPH VACCARO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 S COAST DR
COSTA MESA CA
92626-1534
US

IV. Provider business mailing address

111W BASTANCHURY RD 1A
FULLERTON CA
92835-2527
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-5440
  • Fax:
Mailing address:
  • Phone: 714-773-4111
  • Fax: 714-773-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY27192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: