Healthcare Provider Details

I. General information

NPI: 1447385992
Provider Name (Legal Business Name): MARISOL VINCENTY PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ING CALLE GALINDE STREET EPS BUILDING OFFICE # G-03 MEDICAL SCIENCE CAMPUS
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

915 CALLE ISAURA ARNAU COUNTRY CLUB 2DA EXT,
SAN JUAN PR
00924-3427
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax: 787-765-6540
Mailing address:
  • Phone: 787-758-2525
  • Fax: 787-776-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number506
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: