Provider Demographics
NPI:1205291127
Name:VINCENTINI, DOMINIC (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:
Last Name:VINCENTINI
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3202
Mailing Address - Country:US
Mailing Address - Phone:402-319-1207
Mailing Address - Fax:
Practice Address - Street 1:641 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-6201
Practice Address - Country:US
Practice Address - Phone:650-498-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer