Healthcare Provider Details

I. General information

NPI: 1013880285
Provider Name (Legal Business Name): KATHALEEN VINASCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CENTURIAN DR STE 110
NEWARK DE
19713-2154
US

IV. Provider business mailing address

1020 WALNUT ST
PHILADELPHIA PA
19107-5567
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-0900
  • Fax: 302-355-0901
Mailing address:
  • Phone: 484-487-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012428
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: