Provider Demographics
NPI:1932145265
Name:VANCE, WARREN TAYLOR (M D)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:TAYLOR
Last Name:VANCE
Suffix:
Gender:M
Credentials:M D
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 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-344-2070
Mailing Address - Fax:530-295-0400
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2070
Practice Address - Fax:530-295-0400
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72739207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727390Medicaid
CAH36627Medicare UPIN
CA00A727390Medicaid