Provider Demographics
NPI:1114084852
Name:VINCE, ROSA ELENA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ELENA
Last Name:VINCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 3RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3541
Mailing Address - Country:US
Mailing Address - Phone:415-454-3717
Mailing Address - Fax:415-454-4077
Practice Address - Street 1:361 3RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3541
Practice Address - Country:US
Practice Address - Phone:415-454-3717
Practice Address - Fax:415-454-4077
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0189410Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER