MEDICARE: ALIDA ANGEOLINA VINCENTY MA

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	101Y00000X	Counselor	000888	PR

General Provider Information

NPI Number	:	1194292870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIDA ANGEOLINA VINCENTY MA

Provider Business Mailing Address
First Line	:	PROFFESIONAL BUILDING PLAZA
Second Line	:	770 AVE HOSTOS 302A
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680
Country	:	US
Telephone Number	:	787-407-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 AVE HOSTOS STE 302
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1552
Country	:	US
Telephone Number	:	787-407-1490
Fax Number	:

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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Directions to “ ALIDA ANGEOLINA VINCENTY MA” Practice Location

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