Individual
DR. FRED STEVE VERNACCHIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
Mailing address
1100 MONTEREY ST, SUITE 210, SAN LUIS OBISPO, CA 93401-3102
(805) 542-9700
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G51923
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G519230
—
CA
01
—
CH9716
CHAMPUS
CA
01
—
G51923
STATE LICENSE NUMBER
CA
Enumeration date
11/08/2006
Last updated
07/08/2007
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