Jan Raymond Vicencio, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

95003057 Issued in CA

Practice address

2901 W Coast Hwy
Suite 200
Newport Beach, CA 92663-4023

Phone

(562) 229-4813

NPI assigned

Dec 1, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jan Raymond Vicencio Vicencio Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454371200000",
    "number": "1295109304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14733 WOODRUFF PL",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907063270",
            "telephone_number": "562-229-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 W COAST HWY",
            "address_2": "SUITE 200",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926634023",
            "telephone_number": "562-229-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICENCIO",
        "first_name": "JAN",
        "middle_name": "RAYMOND",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-01",
        "last_updated": "2016-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95003057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAN RAYMOND",
            "last_name": "VICENCIO",
            "middle_name": "VICENCIO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Adult Health Nurse Practitioner in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.