Provider Demographics
NPI:1558731943
Name:VINCENT R. SGHIATT, MD, INC
Entity Type:Organization
Organization Name:VINCENT R. SGHIATT, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SGHIATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-823-3443
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5425
Mailing Address - Country:US
Mailing Address - Phone:310-823-3443
Mailing Address - Fax:310-305-7470
Practice Address - Street 1:4560 ADMIRALTY WAY STE 201
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5425
Practice Address - Country:US
Practice Address - Phone:310-823-3443
Practice Address - Fax:310-305-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service