Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 233568 | MA |
NPI | 1336316652 |
---|---|
Provider Name | Dr. Matthew Peter Vance |
First Address | San Diego, CA 92121-6310 |
Second Address | San Diego, CA 92121-6310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 01/07/2013 |