1710173547 NPI number — VICENTE MACO-FLORES M.D.

Table of content: VICENTE MACO-FLORES M.D. (NPI 1710173547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710173547 NPI number — VICENTE MACO-FLORES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACO-FLORES
Provider First Name:
VICENTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710173547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-0361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-328-6746
Provider Business Mailing Address Fax Number:
321-633-4449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 EXECUTIVE LN
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-3590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-806-3949
Provider Business Practice Location Address Fax Number:
321-806-3945
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: ME117647 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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