Healthcare Provider Details

I. General information

NPI: 1114217551
Provider Name (Legal Business Name): ANA CAROLINA VICTORIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE SUITE A100
MIAMI FL
33173-3570
US

IV. Provider business mailing address

7001SW 97TH AVE SUITE 101
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-7998
  • Fax:
Mailing address:
  • Phone: 305-273-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME 109606
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME109606
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberME109606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: