Provider Demographics
NPI:1750469318
Name:SGHIATTI, VINCENT ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ROBERT
Last Name:SGHIATTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1824
Mailing Address - Country:US
Mailing Address - Phone:323-583-5887
Mailing Address - Fax:323-583-6601
Practice Address - Street 1:6316 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1824
Practice Address - Country:US
Practice Address - Phone:323-583-5887
Practice Address - Fax:323-583-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG429260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G429260Medicaid