MEDICARE: DR. JOAN VICENTE 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	207Q00000X	Family Medicine Physician	4301083535	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780791939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN VICENTE M.D.

Provider Business Mailing Address
First Line	:	200 S WELLS RD
Second Line	:	SUITE 200
City	:	VENTURA
State	:	CA
Zip	:	93004-1377
Country	:	US
Telephone Number	:	805-659-1740
Fax Number	:	805-659-9959

Provider Business Practice Location Address
First Line	:	200 S WELLS RD
Second Line	:	SUITE 200
City	:	VENTURA
State	:	CA
Zip	:	93004-1377
Country	:	US
Telephone Number	:	805-659-1740
Fax Number	:	805-659-9959

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/21/2013

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