# J S VINCENT MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164021598
- **Authorized official:** JOHN BUTORA (BILLING MANAGER)
- **Authorized official phone:** (562) 787-0225

## Contact information

- **Practice address:** 3111 LOS FELIZ BLVD STE 103, LOS ANGELES, CA 90039-1599
- **Practice address phone:** (770) 895-8483
- **Mailing address:** 3111 LOS FELIZ BLVD STE 103, LOS ANGELES, CA 90039-1599
- **Mailing address phone:** (770) 895-8483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | NULL | Yes |
| 2082S0099X | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2020
- **Last updated:** 10/18/2020