Provider Demographics
NPI:1043503337
Name:VICENCIO, NAYELLY
Entity type:Individual
Prefix:
First Name:NAYELLY
Middle Name:
Last Name:VICENCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S MAGNOLIA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-5224
Mailing Address - Country:US
Mailing Address - Phone:619-442-5434
Mailing Address - Fax:
Practice Address - Street 1:330 S MAGNOLIA AVE STE 302
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-5224
Practice Address - Country:US
Practice Address - Phone:619-442-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator