Healthcare Provider Details

I. General information

NPI: 1164415220
Provider Name (Legal Business Name): VINCON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5732 CANTON CV
WINTER SPRINGS FL
32708-5079
US

IV. Provider business mailing address

5732 CANTON CV
WINTER SPRINGS FL
32708-5079
US

V. Phone/Fax

Practice location:
  • Phone: 407-699-7787
  • Fax: 407-699-7963
Mailing address:
  • Phone: 407-699-7787
  • Fax: 407-699-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME73272
License Number StateFL

VIII. Authorized Official

Name: DR. VINCENZO GIULIANO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 407-699-7787