Provider Demographics
NPI:1285720698
Name:VINTAS, GUSTAVO HORACIO (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:HORACIO
Last Name:VINTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9000 CYNTHIA STREET, SUITE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-266-3776
Mailing Address - Fax:310-550-7424
Practice Address - Street 1:9000 CYNTHIA STREET, SUITE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-266-3776
Practice Address - Fax:310-734-7132
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA408322084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry