Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 36980 | KY |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD432714 | PA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME126126 | FL |
NPI | 1083660351 |
---|---|
Provider Name | Dr. Wilfred M Victorina |
First Address | Palm Coast, FL 32135-0812 |
Second Address | Palm Coast, FL 32137-3672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2517486 | (05) | OH |
64041114 | (05) | KY |
H46617 | (02) | KY |
H46617 | (02) | PA |