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General NPI Number Information
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NPI Number | 1346321734
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Entity Type | Organization
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Legal Business Name | VICTORIA MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 5801 NW 151ST ST STE 203
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-822-4447
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Fax | 305-822-4484
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Provider Business Mailing Address
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Address Line | 5801 NW 151ST ST STE 203
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2437
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Country | US
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Telephone | 305-822-4447
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Fax | 305-822-4484
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALTAGRACIA ADALGIZA VICTORIA
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Credential | MD
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Telephone | 305-822-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME-0070097
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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