Provider Demographics
NPI:1871891747
Name:VICENCIO, ARLENE ACOSTA (PA)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:ACOSTA
Last Name:VICENCIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48942 WOODGROVE CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7586
Mailing Address - Country:US
Mailing Address - Phone:408-813-5558
Mailing Address - Fax:
Practice Address - Street 1:2425 EAST ST
Practice Address - Street 2:#15
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1926
Practice Address - Country:US
Practice Address - Phone:925-682-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant