Healthcare Provider Details

I. General information

NPI: 1649249178
Provider Name (Legal Business Name): VINCENT THOMAS ELLIOTT RN, MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 PICCADILLY PL
SAN BRUNO CA
94066-2117
US

IV. Provider business mailing address

121- H PICCADILLY PLACE
SAN BRUNO CA
94066-2117
US

V. Phone/Fax

Practice location:
  • Phone: 650-952-6692
  • Fax:
Mailing address:
  • Phone: 650-952-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN 310069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: