Provider Demographics
NPI:1851752067
Name:VICENT, VALERIE ROSE (DC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ROSE
Last Name:VICENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3728
Mailing Address - Country:US
Mailing Address - Phone:760-783-0105
Mailing Address - Fax:760-783-0193
Practice Address - Street 1:447 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3728
Practice Address - Country:US
Practice Address - Phone:760-783-0105
Practice Address - Fax:760-783-0193
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor