Healthcare Provider Details

I. General information

NPI: 1689878225
Provider Name (Legal Business Name): VINCENZO (NONE) VITTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NORTHRIDGE RD
SANTA BARBARA CA
93105-1930
US

IV. Provider business mailing address

306 NORTHRIDGE RD
SANTA BARBARA CA
93105-1930
US

V. Phone/Fax

Practice location:
  • Phone: 516-996-3610
  • Fax:
Mailing address:
  • Phone: 516-996-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A10844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: