Healthcare Provider Details

I. General information

NPI: 1225307085
Provider Name (Legal Business Name): VICTOR ARTURO MARMOLEJOS POLANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

IV. Provider business mailing address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

V. Phone/Fax

Practice location:
  • Phone: 407-569-1260
  • Fax: 833-963-0109
Mailing address:
  • Phone: 407-569-1260
  • Fax: 833-963-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME126997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: