Provider Demographics
NPI:1285821785
Name:DE LA OSSA, VINCENT (IDC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:DE LA OSSA
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HM1 DE LA OSSA, VINCENT (MEDICAL DEPT)
Mailing Address - Street 2:USS BOONE (FFG28)
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:34093 1484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HM1 DE LA OSSA, VINCENT (MEDICAL DEPT)
Practice Address - Street 2:USS BOONE (FFG28)
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:34093 1484
Practice Address - Country:US
Practice Address - Phone:904-270-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman