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General NPI Number Information
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NPI Number | 1760442750
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Entity Type | Individual
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Provider Name | CHRIS MICHAEL VICENTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 1207 ARISTA DR STE 103
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City | ROCKWALL
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State | TX
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Zip | 75032-6657
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Country | US
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Telephone | 214-703-1900
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Fax | 214-703-1901
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Provider Business Mailing Address
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Address Line | 3523 MCKINNEY AVE STE 735
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City | DALLAS
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State | TX
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Zip | 75204-1401
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Country | US
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Telephone | 214-703-1900
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Fax | 214-703-1901
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME82475
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | M3414
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | M3414
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License Number State | TX
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