Healthcare Provider Details

I. General information

NPI: 1952143836
Provider Name (Legal Business Name): VINCENT BUCCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 E LAKE MEAD BLVD STE M
NORTH LAS VEGAS NV
89030-7134
US

IV. Provider business mailing address

1820 E LAKE MEAD BLVD STE M
NORTH LAS VEGAS NV
89030-7134
US

V. Phone/Fax

Practice location:
  • Phone: 702-916-3537
  • Fax:
Mailing address:
  • Phone: 702-916-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: