Healthcare Provider Details

I. General information

NPI: 1952118622
Provider Name (Legal Business Name): VICTORIA KUTA MD, FRCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. VICTORIA KUTA VINCENTI

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MEMORIAL MEDICAL PKWY STE 208
DAYTONA BEACH FL
32117-5169
US

IV. Provider business mailing address

305 MEMORIAL MEDICAL PKWY STE 208
DAYTONA BEACH FL
32117-5169
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME177293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: