Healthcare Provider Details

I. General information

NPI: 1104745769
Provider Name (Legal Business Name): ANDREA NATASHA VICENTE SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 18 BOX 759
SAN JUAN PR
00926-9809
US

IV. Provider business mailing address

RR 18 BOX 759
SAN JUAN PR
00926-9809
US

V. Phone/Fax

Practice location:
  • Phone: 787-501-3944
  • Fax:
Mailing address:
  • Phone: 787-501-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9227
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: