MEDICARE: DR. JOSE J VICENS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	15954	SC

General Provider Information

NPI Number	:	1134109952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE J VICENS M.D.

Provider Business Mailing Address
First Line	:	4250 GRANBY ST UNIT 207
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-1127
Country	:	US
Telephone Number	:	757-553-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 GRANBY ST UNIT 207
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-1127
Country	:	US
Telephone Number	:	757-553-2910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	12/11/2024

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