Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G54133 | CA |
NPI | 1205869849 |
---|---|
Provider Name | Ernest Joseph Vasti |
First Address | Stockton, CA 95204 |
Second Address | Rancho Cordova, CA 95670-1935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 05/11/2020 |