Provider Demographics
NPI:1447880786
Name:VICENTE, MARYSOL (MD)
Entity type:Individual
Prefix:DR
First Name:MARYSOL
Middle Name:
Last Name:VICENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7147
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-9295
Mailing Address - Country:US
Mailing Address - Phone:787-242-7101
Mailing Address - Fax:
Practice Address - Street 1:53-1 CALLE 60A
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-3871
Practice Address - Country:US
Practice Address - Phone:787-242-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice