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General NPI Number Information
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NPI Number | 1255795662
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Entity Type | Organization
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Legal Business Name | VACCA,MORGAN,KHOSLA,LEPPLA,DEMERS,SEKHON,& BLAKE, LTD
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 611 WEST LINE STREET
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City | BISHOP
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State | CA
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Zip | 93514-3314
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Country | US
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Telephone | 775-789-3986
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Fax |
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Provider Business Mailing Address
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Address Line | 5590 KIETZKE LN
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City | RENO
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State | NV
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Zip | 89511-3019
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Country | US
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Telephone | 775-789-3986
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DAVID C LEPPLA
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Credential | M.D.
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Telephone | 775-789-3986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A116313
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A91029
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C52516
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A95206
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G87027
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License Number State | CA
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