Healthcare Provider Details

I. General information

NPI: 1033171517
Provider Name (Legal Business Name): VICTOR I TAMAYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

IV. Provider business mailing address

301 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

V. Phone/Fax

Practice location:
  • Phone: 305-940-0522
  • Fax: 305-653-1138
Mailing address:
  • Phone: 305-940-0522
  • Fax: 305-653-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0077891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: