Healthcare Provider Details

I. General information

NPI: 1639145055
Provider Name (Legal Business Name): VICTORIA CAROLINA ARRAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8274 BAYBERRY RD UFJP BAYMEADOWS ROAD
JACKSONVILLE FL
32256-7470
US

IV. Provider business mailing address

PO BOX 44008 UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0800
  • Fax: 904-633-0381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME61734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: