Provider Demographics
NPI:1659487288
Name:O'DONNELL, VINCENT ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:O'DONNELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 905
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-977-1211
Mailing Address - Fax:213-977-0625
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 905
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-1211
Practice Address - Fax:213-977-0625
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2012-03-13
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Provider Licenses
StateLicense IDTaxonomies
CAA24882208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5607416OtherMEDI-CAL PIN
CAA83129Medicare UPIN