=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225307085
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTOR ARTURO MARMOLEJOS POLANCO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2011
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3185 W VINE ST
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-569-1260
-----------------------------------------------------
Fax | 833-963-0109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3185 W VINE ST
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-3738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-569-1260
-----------------------------------------------------
Fax | 833-963-0109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME126997
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------