Healthcare Provider Details

I. General information

NPI: 1427104579
Provider Name (Legal Business Name): JOSE LUIS VICENS-SALGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVAR DEL RIO RAMAL 3
HUMACAO PR
00791-9998
US

IV. Provider business mailing address

155 WOOD LN
HUMACAO PR
00791-6027
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax: 787-739-8190
Mailing address:
  • Phone: 787-627-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10848
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: