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General NPI Number Information
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NPI Number | 1285679233
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Entity Type | Individual
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Provider Name | VINCENT LEROY DESTIGTER RCP 9059
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 723 COURT ST
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City | JACKSON
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State | CA
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Zip | 95642-2129
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Country | US
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Telephone | 209-223-7306
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Fax | 209-223-7309
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Provider Business Mailing Address
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Address Line | 26510 SUGAR PINE DR
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City | PIONEER
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State | CA
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Zip | 95666-9578
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Country | US
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Telephone | 209-295-7831
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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 | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | RCP9059
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License Number State | CA
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