Provider Demographics
NPI:1790441913
Name:VINCENT, OVIE FRANK
Entity Type:Individual
Prefix:MR
First Name:OVIE
Middle Name:FRANK
Last Name:VINCENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-0928
Mailing Address - Country:US
Mailing Address - Phone:909-659-8855
Mailing Address - Fax:
Practice Address - Street 1:31473 OCEAN VIEW DRIVE RUNNING SPRINGS CA 92382
Practice Address - Street 2:
Practice Address - City:RUNNING SPRING
Practice Address - State:CA
Practice Address - Zip Code:92382-9238
Practice Address - Country:US
Practice Address - Phone:909-659-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY8252644343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)