Healthcare Provider Details

I. General information

NPI: 1639370968
Provider Name (Legal Business Name): RAPHAEL R VACCO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RALPH ROBERT VACCO D.C.

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41877 ENTERPRISE CIR N SUITE 200-E
TEMECULA CA
92590-5656
US

IV. Provider business mailing address

41877 ENTERPRISE CIR N SUITE 200-E
TEMECULA CA
92590-5656
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-5880
  • Fax: 951-296-5880
Mailing address:
  • Phone: 951-296-5880
  • Fax: 951-296-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: