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General NPI Number Information
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NPI Number | 1033985775
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Entity Type | Individual
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Provider Name | REGINALD MATTHEW VANG
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Gender | Male
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 7000 MICHAEL CANLIS WAY
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City | FRENCH CAMP
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State | CA
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Zip | 95231-9781
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Country | US
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Telephone | 209-468-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 8710 BLUE GRASS DR
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City | STOCKTON
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State | CA
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Zip | 95210-4416
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Country | US
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Telephone | 209-990-1320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 733259
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License Number State | CA
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