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General NPI Number Information
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NPI Number | 1487166294
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Entity Type | Individual
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Provider Name | TERESITA VICENTE DC, MS
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Gender | Female
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 617 CALLE HILLSIDE
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City | SAN JUAN
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State | PR
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Zip | 00920-4370
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Country | US
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Telephone | 787-731-1575
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Fax |
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Provider Business Mailing Address
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Address Line | 701 W DR MARTIN LUTHER KING JR BLVD STE 4
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City | TAMPA
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State | FL
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Zip | 33603-3100
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Country | US
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Telephone | 813-906-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 643
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License Number State | PR
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