Provider Demographics
NPI:1235450834
Name:SOUN, VINCENT V (MD MPH MAJOR)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:V
Last Name:SOUN
Suffix:
Gender:M
Credentials:MD MPH MAJOR
Other - Prefix:DR
Other - First Name:VINCENT
Other - Middle Name:VISTH
Other - Last Name:SOUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MPH MAJOR
Mailing Address - Street 1:529 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1121
Mailing Address - Country:US
Mailing Address - Phone:760-756-3172
Mailing Address - Fax:760-756-3150
Practice Address - Street 1:529 PINE AVE
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1121
Practice Address - Country:US
Practice Address - Phone:760-756-3172
Practice Address - Fax:760-756-3150
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2158741Medicaid