Individual
DR. VINCENT DONALD LEPORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2581 SAMARITAN DR, SUITE 102, SAN JOSE, CA 95124-4113
(408) 356-4241
(408) 356-4924
Mailing address
2581 SAMARITAN DR, SUITE 102, SAN JOSE, CA 95124-4113
(408) 356-4241
(408) 356-4924
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G048588
CA
208200000X
Plastic Surgery Physician
G048588
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G048588
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G485880
MEDICARE ID
CA
01
—
1578689592
GRP NPI
CA
01
—
770142258
TAX ID
CA
01
—
770142558
GRP TAX ID
CA
01
—
G048588
CA LICENSE
CA
01
—
ZZZ15680Z
PTAN
CA
01
—
ZZZ15681Z
BCBS
CA
Enumeration date
06/03/2006
Last updated
08/30/2010
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