Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | ME130111 | FL |
NPI | 1023364387 |
---|---|
Provider Name | Dr. Vinicius Costa Diniz Domingues |
First Address | Daytona Beach, FL 32114-1603 |
Second Address | Daytona Beach, FL 32114-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 10/01/2018 |