Healthcare Provider Details

I. General information

NPI: 1356389241
Provider Name (Legal Business Name): DR. VINCENT DONALD LEPORE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 SAMARITAN DR SUITE 102
SAN JOSE CA
95124-4113
US

IV. Provider business mailing address

2581 SAMARITAN DR SUITE 102
SAN JOSE CA
95124-4113
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-4241
  • Fax: 408-356-4924
Mailing address:
  • Phone: 408-356-4241
  • Fax: 408-356-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG048588
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG048588
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG048588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: