Provider Demographics
NPI:1417496001
Name:VICTORIA MEDICAL CANCUN SA DE CV
Entity Type:Organization
Organization Name:VICTORIA MEDICAL CANCUN SA DE CV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISTOBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-903-7445
Mailing Address - Street 1:PO BOX 11597
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AV. SUNYAXCHEN, MZ 6 LT 59 SM 25
Practice Address - Street 2:
Practice Address - City:CANCUN
Practice Address - State:QUINTANA ROO
Practice Address - Zip Code:77509
Practice Address - Country:MX
Practice Address - Phone:954-903-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital