MEDICARE: DR. CARLOS M VICTORICA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M6934	TX
2	207Q00000X	Family Medicine Physician	74268	GA
3	207Q00000X	Family Medicine Physician	ME134729	FL

General Provider Information

NPI Number	:	1396945648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS M VICTORICA MD

Provider Business Mailing Address
First Line	:	1001 NW 13TH ST STE 201
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-2269
Country	:	US
Telephone Number	:	561-955-6975
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301A W PALMETTO PARK RD STE 100B
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3403
Country	:	US
Telephone Number	:	561-955-5761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	02/27/2019

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