Individual
JAN RAYMOND VICENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
2901 W COAST HWY, SUITE 200, NEWPORT BEACH, CA 92663-4023
(562) 229-4813
Mailing address
14733 WOODRUFF PL, BELLFLOWER, CA 90706-3270
(562) 229-4813
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95003057
CA
Other
Enumeration date
12/01/2015
Last updated
02/02/2016
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