Provider Demographics
NPI:1356389241
Name:LEPORE, VINCENT DONALD JR
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:DONALD
Last Name:LEPORE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 SAMARITAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4113
Mailing Address - Country:US
Mailing Address - Phone:408-356-4241
Mailing Address - Fax:408-356-4924
Practice Address - Street 1:2581 SAMARITAN DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4113
Practice Address - Country:US
Practice Address - Phone:408-356-4241
Practice Address - Fax:408-356-4924
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048588174400000X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770142258OtherTAX ID
CA770142558OtherGRP TAX ID
CAZZZ15680ZOtherPTAN
CAG048588OtherCA LICENSE
CA00G485880OtherMEDICARE ID
CA1578689592OtherGRP NPI
CAZZZ15681ZOtherBCBS
CAZZZ15681ZOtherPTAN
CAG048588OtherCA LICENSE