Provider Demographics
NPI:1518167303
Name:VICENT, ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:VICENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 AVE ISLA VERDE
Mailing Address - Street 2:APT. 605
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-4999
Mailing Address - Country:US
Mailing Address - Phone:787-728-1944
Mailing Address - Fax:
Practice Address - Street 1:4327 AVE ISLA VERDE
Practice Address - Street 2:APT. 605
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-4999
Practice Address - Country:US
Practice Address - Phone:787-728-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2940207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2940OtherMEDICAL LICENSE