1003563479 NPI number — MISS ZULAY YESENIA VICENTE LCDA

Table of content: MISS ZULAY YESENIA VICENTE LCDA (NPI 1003563479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003563479 NPI number — MISS ZULAY YESENIA VICENTE LCDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICENTE
Provider First Name:
ZULAY
Provider Middle Name:
YESENIA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCDA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VICENTE
Provider Other First Name:
ZULAY
Provider Other Middle Name:
YESENIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCDA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003563479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
397 CALLE ANDRADES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATANO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00962-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-446-4045
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
397 CALLE ANDRADES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATANO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00962-5060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-446-4045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  7296 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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