Provider Demographics
NPI:1376600262
Name:DELGADILLO, VINCE GABRIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:VINCE
Middle Name:GABRIEL
Last Name:DELGADILLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARIN CENTER DR APT 26
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2711
Mailing Address - Country:US
Mailing Address - Phone:415-444-2990
Mailing Address - Fax:415-482-6726
Practice Address - Street 1:1033 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3107
Practice Address - Country:US
Practice Address - Phone:415-444-2990
Practice Address - Fax:415-482-6726
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11349T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist