Individual
MR. SPENCER M VILA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9251 FIFE RANCH WAY, ELK GROVE, CA 95624-3575
(815) 514-6686
Mailing address
9251 FIFE RANCH WAY, ELK GROVE, CA 95624-3575
(815) 514-6686
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
35684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12345
—
CA
Enumeration date
05/15/2014
Last updated
05/15/2014
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