Healthcare Provider Details

I. General information

NPI: 1134188527
Provider Name (Legal Business Name): MEDICAL CLINIC FOR NONINVASIVE VASCULAR STUDIES OF SOLANO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 COLUSA ST
VALLEJO CA
94590-4565
US

IV. Provider business mailing address

1040 COLUSA ST
VALLEJO CA
94590-4565
US

V. Phone/Fax

Practice location:
  • Phone: 707-644-1067
  • Fax: 707-644-5810
Mailing address:
  • Phone: 707-644-1067
  • Fax: 707-644-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberZZZ17818Z
License Number StateCA

VIII. Authorized Official

Name: DR. PETER VINCENT LEONI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 707-644-1067