=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205928231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR VERJANO D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 04/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 W 46TH ST SUITE 10
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-828-9383
-----------------------------------------------------
Fax | 305-822-0109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 W 46TH ST SUITE 10
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-3283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-828-9383
-----------------------------------------------------
Fax | 305-822-0109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO2688
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------