Healthcare Provider Details

I. General information

NPI: 1215983739
Provider Name (Legal Business Name): DANTE F VACCA MD CHTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KIRMAN AVE SUITE 202
RENO NV
89502-1339
US

IV. Provider business mailing address

85 KIRMAN AVE SUITE 202
RENO NV
89502-1339
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-2080
  • Fax:
Mailing address:
  • Phone: 775-323-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5826
License Number StateNV

VIII. Authorized Official

Name: DANTE F VACCA
Title or Position: OWNER
Credential: M.D.
Phone: 775-323-2080