Provider Demographics
NPI:1881885713
Name:GRANDE, VINCENT SAMUEL (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:SAMUEL
Last Name:GRANDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WILSHIRE BLVD
Mailing Address - Street 2:#2804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 W DEL MAR BLVD
Practice Address - Street 2:#100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2505
Practice Address - Country:US
Practice Address - Phone:213-925-8320
Practice Address - Fax:323-517-2222
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor