Provider Demographics
NPI:1225307085
Name:MARMOLEJOS, VICTOR ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ARTURO
Last Name:MARMOLEJOS
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 1:3185 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3738
Mailing Address - Country:US
Mailing Address - Phone:407-569-1260
Mailing Address - Fax:833-963-0109
Practice Address - Street 1:3185 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3738
Practice Address - Country:US
Practice Address - Phone:407-569-1260
Practice Address - Fax:833-963-0109
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
FLME126997207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME126997OtherME LICENSE
FLFM3343744OtherDEA CERTIFICATE
FLIP366XMedicare PIN
FLIP366ZMedicare PIN
FLME126997OtherME LICENSE