Provider Demographics
NPI:1457591919
Name:SALAS VINCENTY, JANICE (OD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:SALAS VINCENTY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BE24 PLAZA 13
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1018 AVE ASHFORD
Practice Address - Street 2:SUITE 1 A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2108
Practice Address - Country:US
Practice Address - Phone:787-624-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist