Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A158908 | CA |
N | 111NI0900X | Internist | A158908 | CA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A158908 | CA |
NPI | 1053727305 |
---|---|
Provider Name | Deepa Vincent |
First Address | San Leandro, CA 94578 |
Second Address | San Leandro, CA 94578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 28/10/2020 |