Provider Demographics
NPI:1295707743
Name:ANQUE, VICENTA CUNTAPAY (FNP)
Entity type:Individual
Prefix:MRS
First Name:VICENTA
Middle Name:CUNTAPAY
Last Name:ANQUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W COLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9722
Mailing Address - Country:US
Mailing Address - Phone:760-357-2020
Mailing Address - Fax:760-357-1056
Practice Address - Street 1:1166 K ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2737
Practice Address - Country:US
Practice Address - Phone:760-344-9951
Practice Address - Fax:760-344-1629
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345872163W00000X
CA12183163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse