Provider Demographics
NPI:1467690362
Name:VINNECOUR, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:VINNECOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WILSHIRE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5211
Mailing Address - Country:US
Mailing Address - Phone:323-866-2555
Mailing Address - Fax:
Practice Address - Street 1:6300 WILSHIRE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5211
Practice Address - Country:US
Practice Address - Phone:323-866-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist