Provider Demographics
NPI:1548928112
Name:INZANO, VINCENT THOMAS
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:THOMAS
Last Name:INZANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VINNIE
Other - Middle Name:THOMAS
Other - Last Name:INZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7986 DAGGET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2321
Mailing Address - Country:US
Mailing Address - Phone:619-809-5752
Mailing Address - Fax:
Practice Address - Street 1:7986 DAGGET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2321
Practice Address - Country:US
Practice Address - Phone:619-809-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health