Provider Demographics
NPI:1952832032
Name:VINCENT V. SOUN MD, INC.
Entity Type:Organization
Organization Name:VINCENT V. SOUN MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:SOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-352-3108
Mailing Address - Street 1:1484 S IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4200
Mailing Address - Country:US
Mailing Address - Phone:760-352-3108
Mailing Address - Fax:760-352-3234
Practice Address - Street 1:1484 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4200
Practice Address - Country:US
Practice Address - Phone:760-352-3108
Practice Address - Fax:760-352-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care