Provider Demographics
NPI:1649430448
Name:VINIKAS, BRUCE (DOM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:VINIKAS
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CRYSTAL VW S
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4807
Mailing Address - Country:US
Mailing Address - Phone:407-321-1377
Mailing Address - Fax:407-321-7688
Practice Address - Street 1:101 CRYSTAL VW S
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4807
Practice Address - Country:US
Practice Address - Phone:407-321-1377
Practice Address - Fax:407-321-7688
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP549OtherFLORIDA DEPT OF HEALTH AND PROFESSIONAL REGULATION