Provider Demographics
NPI:1255795662
Name:VACCA,MORGAN,KHOSLA,LEPPLA,DEMERS,SEKHON,& BLAKE, LTD
Entity type:Organization
Organization Name:VACCA,MORGAN,KHOSLA,LEPPLA,DEMERS,SEKHON,& BLAKE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEPPLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-789-3986
Mailing Address - Street 1:5590 KIETZKE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3019
Mailing Address - Country:US
Mailing Address - Phone:775-789-3986
Mailing Address - Fax:
Practice Address - Street 1:611 WEST LINE STREET
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3314
Practice Address - Country:US
Practice Address - Phone:775-789-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116313174400000X
CAA91029174400000X
CAC52516174400000X
CAA95206174400000X
CAG87027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty