Provider Demographics
NPI:1295716124
Name:DIMAYUGA, VICTORIA P (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:P
Last Name:DIMAYUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 IROQUOIS TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4333
Mailing Address - Country:US
Mailing Address - Phone:386-615-0366
Mailing Address - Fax:
Practice Address - Street 1:16 IROQUOIS TRL
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4333
Practice Address - Country:US
Practice Address - Phone:386-615-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0531852084P0800X
FLME 0531852084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47814Medicare UPIN
07821Medicare ID - Type Unspecified