Provider Demographics
NPI:1427104579
Name:VICENS-SALGADO, JOSE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:VICENS-SALGADO
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 1:44 CALLE HIGUERETA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9650
Mailing Address - Country:US
Mailing Address - Phone:787-712-4914
Mailing Address - Fax:
Practice Address - Street 1:4 FLOR GERENA
Practice Address - Street 2:DELGADO MEDICAL BUILDING
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-285-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist