Provider Demographics
NPI:1952330508
Name:VICTORES, LUIS JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:JAVIER
Last Name:VICTORES
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 1:315 W 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3715
Mailing Address - Country:US
Mailing Address - Phone:305-820-4426
Mailing Address - Fax:305-820-4436
Practice Address - Street 1:315 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3715
Practice Address - Country:US
Practice Address - Phone:305-820-4426
Practice Address - Fax:305-820-4436
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79770207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259075100Medicaid
FLH24208Medicare UPIN
FLE4543Medicare ID - Type Unspecified