Provider Demographics
NPI:1316903529
Name:LICEN, VICENTE SOCO (MD)
Entity type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:SOCO
Last Name:LICEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2506
Mailing Address - Country:US
Mailing Address - Phone:804-541-8812
Mailing Address - Fax:804-541-1396
Practice Address - Street 1:308 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2506
Practice Address - Country:US
Practice Address - Phone:804-541-8812
Practice Address - Fax:804-541-1396
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227471208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics