Provider Demographics
NPI:1447385992
Name:VINCENTY, MARISOL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:VINCENTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CALLE ISAURA ARNAU
Mailing Address - Street 2:COUNTRY CLUB 2DA EXT,
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3427
Mailing Address - Country:US
Mailing Address - Phone:787-758-2525
Mailing Address - Fax:787-776-8322
Practice Address - Street 1:ING CALLE GALINDE STREET EPS BUILDING
Practice Address - Street 2:OFFICE # G-03 MEDICAL SCIENCE CAMPUS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-765-6540
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR506231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist