Provider Demographics
NPI:1285679233
Name:DESTIGTER, VINCENT LEROY (RCP 9059)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:LEROY
Last Name:DESTIGTER
Suffix:
Gender:M
Credentials:RCP 9059
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26510 SUGAR PINE DR
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:CA
Mailing Address - Zip Code:95666-9578
Mailing Address - Country:US
Mailing Address - Phone:209-295-7831
Mailing Address - Fax:
Practice Address - Street 1:723 COURT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2129
Practice Address - Country:US
Practice Address - Phone:209-223-7306
Practice Address - Fax:209-223-7309
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP9059227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified