Provider Demographics
NPI:1952143836
Name:BUCCA, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:BUCCA
Suffix:
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 1:1820 E LAKE MEAD BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7134
Mailing Address - Country:US
Mailing Address - Phone:702-916-3537
Mailing Address - Fax:
Practice Address - Street 1:1820 E LAKE MEAD BLVD STE M
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7134
Practice Address - Country:US
Practice Address - Phone:702-916-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker