Provider Demographics
NPI:1255128864
Name:GAINES, VINCENT EDWARD
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:EDWARD
Last Name:GAINES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 COACH DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-4205
Mailing Address - Country:US
Mailing Address - Phone:925-913-9073
Mailing Address - Fax:
Practice Address - Street 1:118 MONTE VERDE WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2718
Practice Address - Country:US
Practice Address - Phone:925-913-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care