Provider Demographics
NPI:1063288918
Name:VASSALLO VISSEPO, CAMILA ISABEL SR
Entity type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:ISABEL
Last Name:VASSALLO VISSEPO
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB TERRALINDA
Mailing Address - Street 2:#8 CALLE CORDOVA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-2517
Mailing Address - Country:US
Mailing Address - Phone:787-633-1190
Mailing Address - Fax:787-746-5433
Practice Address - Street 1:URB HYDE PARK 285 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3901
Practice Address - Country:US
Practice Address - Phone:787-436-5595
Practice Address - Fax:787-746-5433
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor