Provider Demographics
NPI:1205952033
Name:VINTIMILLA, MARIA VICTORIA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VICTORIA
Last Name:VINTIMILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N DIXIE FWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6201
Mailing Address - Country:US
Mailing Address - Phone:386-423-0505
Mailing Address - Fax:
Practice Address - Street 1:1055 N DIXIE FWY
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6201
Practice Address - Country:US
Practice Address - Phone:386-423-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99745207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002427700Medicaid