Provider Demographics
NPI:1609899004
Name:PUNTURERE, VINCENT ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:PUNTURERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 S BEVERLY DR
Mailing Address - Street 2:STE. 410
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1153
Mailing Address - Country:US
Mailing Address - Phone:310-277-0220
Mailing Address - Fax:310-277-0110
Practice Address - Street 1:1180 S BEVERLY DR
Practice Address - Street 2:STE. 410
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1153
Practice Address - Country:US
Practice Address - Phone:310-277-0220
Practice Address - Fax:310-277-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor