Provider Demographics
NPI:1578246864
Name:VICENTE-SANTOS, JOAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:VICENTE-SANTOS
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:SABANA HOYOS
Mailing Address - Street 2:HC 02 BOX 3128
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00688
Mailing Address - Country:US
Mailing Address - Phone:787-356-8413
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA SERENA
Practice Address - Street 2:CALLE PASCUA L5
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-356-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1750363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical