Healthcare Provider Details

I. General information

NPI: 1578657482
Provider Name (Legal Business Name): VINCENT JOSEPH GUZZETTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR 450
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR 450
LA MESA CA
91942-3068
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-6200
  • Fax: 619-460-6262
Mailing address:
  • Phone: 619-460-6200
  • Fax: 619-460-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG29317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: