Provider Demographics
NPI:1003008616
Name:STEPHEN A VANNUCCI MD INC
Entity Type:Organization
Organization Name:STEPHEN A VANNUCCI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VANNUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-342-3686
Mailing Address - Street 1:251 COHASSET RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2241
Mailing Address - Country:US
Mailing Address - Phone:530-342-3686
Mailing Address - Fax:530-879-3040
Practice Address - Street 1:251 COHASSET RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2241
Practice Address - Country:US
Practice Address - Phone:530-342-3686
Practice Address - Fax:530-879-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71303207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A713030Medicaid
CAZZZ23917ZMedicare PIN