Healthcare Provider Details

I. General information

NPI: 1710943311
Provider Name (Legal Business Name): LUIS MANUEL VINUELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SHERIDAN RD
MELBOURNE FL
32901-3122
US

IV. Provider business mailing address

2690 RANCHWOOD CT
MELBOURNE FL
32934-7542
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-5200
  • Fax:
Mailing address:
  • Phone: 321-426-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0094555
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME0094555
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: