Individual
MR. VINCENT MICHAEL DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1831 TRUDGEON AVE, LANCASTER, CA 93535-4354
(661) 202-7635
Mailing address
1831 TRUDGEON AVE, LANCASTER, CA 93535-4354
(661) 202-7635
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3528136
STATE DRIVERS LICENSE
CA
Enumeration date
07/05/2022
Last updated
07/05/2022
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