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General NPI Number Information
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NPI Number | 1821258419
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Entity Type | Individual
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Provider Name | VINCENT DEGENNARO JR. MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 6333 N FEDERAL HWY STE 301302
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-1907
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Country | US
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Telephone | 954-772-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 6255 W SUNSET BLVD FL 21
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City | LOS ANGELES
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State | CA
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Zip | 90028-7422
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Country | US
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Telephone | 323-860-5200
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 255868
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME115181
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License Number State | FL
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