Healthcare Provider Details

I. General information

NPI: 1790441913
Provider Name (Legal Business Name): MR. OVIE FRANK VINCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 10/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31473 OCEAN VIEW DRIVE RUNNING SPRINGS CA 92382
RUNNING SPRING CA
92382-9238
US

IV. Provider business mailing address

PO BOX 928
RUNNING SPRINGS CA
92382-0928
US

V. Phone/Fax

Practice location:
  • Phone: 909-659-8855
  • Fax:
Mailing address:
  • Phone: 909-659-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberY8252644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: