Individual
MR. BENJAMIN GORDON VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, BSN
Contact information
Practice address
4150 CLEMENT ST, SAN FRANCISCO, CA 94121-1563
(510) 701-5042
Mailing address
551 W GRAND AVE APT 20, OAKLAND, CA 94612-1661
(510) 701-5042
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
813962
CA
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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