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General NPI Number Information
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NPI Number | 1083797013
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Entity Type | Individual
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Provider Name | VINCENT JOSEPH SURACE SR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 928 N WESTERN AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-2427
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Country | US
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Telephone | 310-850-0989
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Fax | 714-547-5694
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Provider Business Mailing Address
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Address Line | 28134 S WESTERN AVE # 196
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City | SAN PEDRO
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State | CA
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Zip | 90732-1248
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Country | US
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Telephone | 310-893-9954
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Fax | 714-547-5694
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-10283
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License Number State | CA
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