Provider Demographics
NPI:1396086443
Name:QUILICI, VINCENT L (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:QUILICI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3601 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-1522
Mailing Address - Country:US
Mailing Address - Phone:916-849-6355
Mailing Address - Fax:916-482-2181
Practice Address - Street 1:3601 MEADOW LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-1522
Practice Address - Country:US
Practice Address - Phone:916-849-6355
Practice Address - Fax:916-482-2181
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA225442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology