Healthcare Provider Details

I. General information

NPI: 1114586583
Provider Name (Legal Business Name): VINCENT PATRICK O'BRIEN GUERRERO MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINCENT PATRICK SITTS O'BRIEN

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 MISSOURI FLAT RD
PLACERVILLE CA
95667-6269
US

IV. Provider business mailing address

4212 MISSOURI FLAT RD
PLACERVILLE CA
95667-6269
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax:
Mailing address:
  • Phone: 530-621-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA182105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: