Provider Demographics
NPI:1427316835
Name:VINCENT, JYOTSNA S (MD)
Entity type:Individual
Prefix:
First Name:JYOTSNA
Middle Name:S
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JYOTSNA
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:110 PARK PLACE
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403
Mailing Address - Country:US
Mailing Address - Phone:415-502-8950
Mailing Address - Fax:415-502-8934
Practice Address - Street 1:110 PARK PLACE
Practice Address - Street 2:STE 100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403
Practice Address - Country:US
Practice Address - Phone:415-502-8950
Practice Address - Fax:415-502-8934
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA141632207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program