Provider Demographics
NPI:1710166913
Name:CUMMINGS, VERNON (RAS)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3323
Mailing Address - Country:US
Mailing Address - Phone:707-558-6432
Mailing Address - Fax:707-558-8047
Practice Address - Street 1:604 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-3323
Practice Address - Country:US
Practice Address - Phone:707-558-6432
Practice Address - Fax:707-558-8047
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0508161719101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480002GNOtherADP CERTIFICATION
CA4825OtherDRUG MEDICAL