Provider Demographics
NPI:1235195744
Name:DIAZ COTRINA, VICTOR ADOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ADOLFO
Last Name:DIAZ COTRINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:ADOLFO
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:32 W GORE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1134
Mailing Address - Country:US
Mailing Address - Phone:407-352-5434
Mailing Address - Fax:407-345-9765
Practice Address - Street 1:32 W GORE ST FL 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1134
Practice Address - Country:US
Practice Address - Phone:407-352-5434
Practice Address - Fax:407-345-9765
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2019-11-15
Deactivation Date:2017-11-02
Deactivation Code:
Reactivation Date:2017-12-06
Provider Licenses
StateLicense IDTaxonomies
WI485272084V0102X, 2084N0400X
FLME1047522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103896400Medicaid
FL009601700Medicaid
WI34772100Medicaid
FL009601700Medicaid
FLHQ741YMedicare PIN
WIW12675003Medicare PIN