Provider Demographics
NPI:1710173547
Name:MACO-FLORES, VICENTE (MD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:MACO-FLORES
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 560361
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-0361
Mailing Address - Country:US
Mailing Address - Phone:386-328-6746
Mailing Address - Fax:321-633-4449
Practice Address - Street 1:835 EXECUTIVE LN
Practice Address - Street 2:#110
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3590
Practice Address - Country:US
Practice Address - Phone:321-806-3949
Practice Address - Fax:321-806-3945
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME117647207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program