MEDICARE: KEITH VINNECOUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1467690362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH VINNECOUR

Provider Business Mailing Address
First Line	:	6300 WILSHIRE BLVD STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5211
Country	:	US
Telephone Number	:	323-866-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 WILSHIRE BLVD STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5211
Country	:	US
Telephone Number	:	323-866-2555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/30/2009

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Directions to “ KEITH VINNECOUR ” Practice Location

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