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Vince Anthony Dutra

Anesthesiology

Allopathic & Osteopathic Physicians

3315 Watt Ave, Sacramento, CA 95821-3600

PECOS Enrollment

This provider is enrolled in PECOS as VINCE DUTRA.

Based on the most recent information from CMS, provider Vince Anthony Dutra is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1568456887
Provider Type
Individual
Full Name
Dutra, Vince Anthony
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
8/31/2005
Last Updated
7/8/2007

Contact Information

Practice Location

3315 Watt Ave, Sacramento, CA 95821-3600

(916) 481-6800

(916) 481-1881

Mailing Location

PO Box 660910, Sacramento, CA 95866-0910

(916) 481-6800

(916) 481-1881

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License G80145 California

Provider Identifiers

ID	Description	Issuer
ID GR0028370	Description Medicaid	Issuer Unlisted California

Vince Anthony Dutra

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Leopold, Gary A

Elliott, Adrian

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Wright, Delbert Loe

Joglekar, Sudhir D

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Downs, David Leroy

Paddock, Karen Louise