1639370968 NPI number — DR. RAPHAEL R VACCO D.C.

Table of content: DR. RAPHAEL R VACCO D.C. (NPI 1639370968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639370968 NPI number — DR. RAPHAEL R VACCO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VACCO
Provider First Name:
RAPHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VACCO
Provider Other First Name:
RALPH
Provider Other Middle Name:
ROBERT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639370968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41877 ENTERPRISE CIR N
Provider Second Line Business Mailing Address:
SUITE 200-E
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92590-5656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-296-5880
Provider Business Mailing Address Fax Number:
951-296-5880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41877 ENTERPRISE CIR N
Provider Second Line Business Practice Location Address:
SUITE 200-E
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92590-5656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-296-5880
Provider Business Practice Location Address Fax Number:
951-296-5880
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC21542 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC21542 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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