Basic Information
| Provider Information | |||||||||
| NPI: | 1902050685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VACI | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LICENSED MFT #50418 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4451 1/2 LOUISIANA STREET | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199421776 | ||||||||
| FaxNumber: | 6195420332 | ||||||||
| Practice Location | |||||||||
| Address1: | 2231 CAMINO DEL RIO SOUTH | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6199421776 | ||||||||
| FaxNumber: | 6192603054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2008 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 50418 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.