Provider Demographics
NPI:1952118622
Name:KUTA-VINCENTI, VICTORIA (MD FRCSC)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:KUTA-VINCENTI
Suffix:
Gender:F
Credentials:MD FRCSC
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:KUTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17 DARJEELING DRIVE
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:NS
Mailing Address - Zip Code:B3P0J9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PLAZA DRIVE STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-773-0385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ018184207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology