Healthcare Provider Details

I. General information

NPI: 1386268209
Provider Name (Legal Business Name): VINCENT ANTONIO DOLL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1802
US

IV. Provider business mailing address

101 BODIN CIR BLDG 777
TRAVIS AFB CA
94535-1802
US

V. Phone/Fax

Practice location:
  • Phone: 661-202-2472
  • Fax:
Mailing address:
  • Phone: 661-202-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: