Provider Demographics
NPI:1043200934
Name:VICTORIA, ALEJANDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:A
Last Name:VICTORIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636987
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6987
Mailing Address - Country:US
Mailing Address - Phone:352-854-0681
Mailing Address - Fax:352-854-8031
Practice Address - Street 1:235 HATTERAS AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2756
Practice Address - Country:US
Practice Address - Phone:352-242-0676
Practice Address - Fax:352-242-1335
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06554OtherBCBS
FL06554OtherBCBS
FL06554OtherBCBS