Provider Demographics
NPI:1215959366
Name:DIMAGGIO, VINCENT PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PATRICK
Last Name:DIMAGGIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3011
Mailing Address - Country:US
Mailing Address - Phone:925-933-4747
Mailing Address - Fax:925-933-1638
Practice Address - Street 1:112 LA CASA VIA STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3011
Practice Address - Country:US
Practice Address - Phone:925-933-4747
Practice Address - Fax:925-933-1638
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40358Medicare UPIN