Healthcare Provider Details

I. General information

NPI: 1346288776
Provider Name (Legal Business Name): VINCENTE LAROCO CARBONELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 RESEARCH DR
SACRAMENTO CA
95838-3257
US

IV. Provider business mailing address

3950 RESEARCH DR
SACRAMENTO CA
95838-3257
US

V. Phone/Fax

Practice location:
  • Phone: 916-648-0970
  • Fax: 916-648-0392
Mailing address:
  • Phone: 916-648-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA35767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: