Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | G39959 | CA |
NPI | 1154497543 |
---|---|
Provider Name | Dr. Don Robert Vanschenck |
First Address | Sacramento, CA 95816-6718 |
Second Address | Sacramento, CA 95825-6207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G399590 | (05) | CA |
D33315 | (02) | CA |
G39959 | CA MEDICAL LICENSE (01) | CA |