Healthcare Provider Details

I. General information

NPI: 1871576579
Provider Name (Legal Business Name): LUIS ANTONIO VINAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S QUADRILLE BLVD STE 100
WEST PALM BEACH FL
33401-5855
US

IV. Provider business mailing address

550 S QUADRILLE BLVD STE 100
WEST PALM BEACH FL
33401-5855
US

V. Phone/Fax

Practice location:
  • Phone: 561-655-3305
  • Fax: 561-655-3951
Mailing address:
  • Phone: 561-655-3305
  • Fax: 561-655-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME57391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: